Get the free VPRIV® PRIOR APPROVAL REQUEST

This document is a request form for prior approval needed to process claims for the prescription drug VPRIV® (Velaglucerase Alfa). It requires completion by both the cardholder and the prescribing

How to fill out vpriv prior approval request

How to fill out VPRIV® PRIOR APPROVAL REQUEST

1. Obtain the VPRIV® Prior Approval Request form from your healthcare provider or pharmacy.
2. Fill out the patient demographics section with the patient's full name, date of birth, and insurance information.
3. Complete the clinical information section, providing details about the patient's medical history, diagnosis, and previous treatments.
4. Include the specific dosage and frequency of VPRIV® that the patient requires.
5. Attach any necessary medical records, lab results, or supporting documentation that justifies the need for VPRIV®.
6. Review the form for completeness and accuracy.
7. Submit the completed form to the insurance company or health plan for approval.
8. Follow up with the insurance provider to check the status of the approval request.

Who needs VPRIV® PRIOR APPROVAL REQUEST?

1. Patients diagnosed with Type 1 Gaucher disease who require treatment.
2. Healthcare providers who prescribe VPRIV® for their patients.
3. Insurance companies that need documentation to process prior approval for coverage of VPRIV®.

People Also Ask about

What is the generic for Vpriv?

Vpriv (velaglucerase alfa) is a form of enzyme replacement therapy (ERT) used to treat Type 1 Gaucher disease in adults and children 4 years of age or older. It's given as an intravenous (IV) infusion by a healthcare provider.

How long does a Vpriv infusion take?

VPRIV is administered as a 60-minute infusion once every other week under the supervision of a healthcare professional. Though the infusion typically takes up to 60 minutes, you may need to stay longer for post-treatment monitoring.

How to reconstitute Vpriv?

Inject 4.3 mL of Sterile Water for Injection, USP, into a vial containing VPRIV powder. Mix gently, do not shake. The reconstituted VPRIV solution will have a 100 U/mL concentration (400 U of VPRIV in 4 mL of solution). If more vials are needed, repeat the above steps.

What is the cost of Vpriv injection?

VPRIV (velaglucerase alfa for injection), 400mcg at ₹ 20000/vial in Jaipur.

For pdfFiller’s FAQs

What is VPRIV® PRIOR APPROVAL REQUEST?

VPRIV® PRIOR APPROVAL REQUEST is a process through which healthcare providers seek authorization from insurance companies or relevant authorities for the use of VPRIV® (velaglucerase alfa), a medication used to treat Gaucher disease, before it can be prescribed.

Who is required to file VPRIV® PRIOR APPROVAL REQUEST?

Healthcare providers, such as physicians or specialists managing a patient's treatment for Gaucher disease, are required to file the VPRIV® PRIOR APPROVAL REQUEST to ensure that the prescribed medication is covered by the patient's insurance.

How to fill out VPRIV® PRIOR APPROVAL REQUEST?

To fill out the VPRIV® PRIOR APPROVAL REQUEST, the healthcare provider must complete the required form with details including patient information, medical history, diagnosis, and the rationale for the medication request, along with any supporting documentation.

What is the purpose of VPRIV® PRIOR APPROVAL REQUEST?

The purpose of the VPRIV® PRIOR APPROVAL REQUEST is to ensure that the treatment plan involving VPRIV® is medically necessary and meets the insurance provider's criteria for coverage, thus facilitating access to the medication for eligible patients.

What information must be reported on VPRIV® PRIOR APPROVAL REQUEST?

The information that must be reported on the VPRIV® PRIOR APPROVAL REQUEST includes the patient's identification details, insurance information, diagnosis of Gaucher disease, previous treatments, the specific request for VPRIV®, and justification for the treatment based on clinical guidelines.