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This document is used to request prior approval for the prescription drug Aldurazyme, requiring information from both the cardholder and the prescribing physician.
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How to fill out aldurazyme prior approval request
How to fill out ALDURAZYME PRIOR APPROVAL REQUEST
01
Obtain the ALDURAZYME Prior Approval Request form from the relevant health authority or insurance provider.
02
Fill in patient information including name, date of birth, and insurance details.
03
Provide the diagnosis information, including specific conditions that ALDURAZYME is intended to treat.
04
Include previous treatment history and responses to any prior therapies.
05
Document any necessary clinical information, including lab results or genetic testing supporting the need for ALDURAZYME.
06
Ensure all required signatures, including from the prescribing physician, are included.
07
Submit the completed request form to the appropriate payer for approval.
Who needs ALDURAZYME PRIOR APPROVAL REQUEST?
01
Patients diagnosed with Mucopolysaccharidosis type I (MPS I), who require ALDURAZYME as part of their treatment plan.
02
Healthcare providers looking to secure coverage for ALDURAZYME on behalf of their patients.
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What is used for?
is used to treat some of the symptoms of a genetic condition called mucopolysaccharidosis or MPS I, also called Hurler syndrome, Hurler-Scheie syndrome, or Scheie syndrome. MPS I is a metabolic disorder in which the body lacks the enzyme needed to break down certain substances.
When was FDA approved?
Laronidase (®) received initial US Food and Drug Administration (FDA) approval on April 30, 2003.
When was approved?
Marketing approved: Generic Name:laronidase Trade Name: Marketing Approval Date: 04/30/2003 Approved Labeled Indication: Treatment for patients with Hurler and Hurler-Scheie forms of Mucopolysaccharidosis I (MPS I) and for patients with the Scheie form who have moderate to severe symptoms3 more rows
What is the cost of ?
(LARONIDASE) Solution for Intravenous Injection - Quality Medicals at ₹ 280000/vial, Palakkad ID: 2856332368848.
Is approved by the FDA?
is an enzyme replacement therapy (ERT) that was approved by the FDA in 2003 for the treatment of Mucopolysaccharidosis type I (MPS I), including patients with Hurler syndrome, Hurler‐Scheie syndrome, and Scheie syndrome with moderate to severe symptoms.
What is the history of ?
was the first drug approved by the United States Food and Drug Administration to be marketed as a treatment for MPS I. It was approved in April 2003. Marketing authorization in the European Union was granted in June 2003 by the European Commission.
How is made?
The active substance in , laronidase, is a copy of the human enzyme ? L iduronidase. It is produced by a method known as 'recombinant DNA technology': the enzyme is made by cells into which a gene (DNA) has been introduced that makes them able to produce laronidase.
What is the therapeutic area of ?
Therapeutic indication is indicated for long-term enzyme replacement therapy in patients with a confirmed diagnosis of mucopolysaccharidosis I (MPS I; alpha-L-iduronidase deficiency) to treat the nonneurological manifestations of the disease.
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What is ALDURAZYME PRIOR APPROVAL REQUEST?
ALDURAZYME PRIOR APPROVAL REQUEST is a form that healthcare providers submit to obtain authorization from insurance companies or payers before administering Aldurazyme, a treatment for a specific metabolic disorder.
Who is required to file ALDURAZYME PRIOR APPROVAL REQUEST?
Healthcare providers, such as physicians and specialists prescribing Aldurazyme, are required to file the ALDURAZYME PRIOR APPROVAL REQUEST.
How to fill out ALDURAZYME PRIOR APPROVAL REQUEST?
To fill out the ALDURAZYME PRIOR APPROVAL REQUEST, providers must gather patient information, treatment details, medical necessity justification, and insurance information before accurately completing the required fields on the form.
What is the purpose of ALDURAZYME PRIOR APPROVAL REQUEST?
The purpose of the ALDURAZYME PRIOR APPROVAL REQUEST is to seek pre-authorization from insurance providers to ensure that the treatment is covered and to confirm that the patient's condition meets the criteria for the specific therapy.
What information must be reported on ALDURAZYME PRIOR APPROVAL REQUEST?
The information that must be reported includes the patient's demographic details, diagnosis, treatment plan, medical history, previous therapies, and the provider's contact information.
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