Get the free Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form

This document is a form for requesting prior authorization of benefits for the medication Neumega (oprelvekin) for patients recovering from chemotherapy, including sections for patient and physician

How to fill out neumega oprelvekin prior authorization

How to fill out Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form

1. Obtain the Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form from your healthcare provider or the insurance company.
2. Fill in your personal information, including name, date of birth, and insurance details at the top of the form.
3. Provide the patient's medical history relevant to the treatment with Neumega®, including diagnosis and previous treatments.
4. Indicate the prescribed dosage and frequency of Neumega® as per your physician's recommendation.
5. Attach any required medical records or documentation that supports the need for Neumega® treatment.
6. Review the completed form for accuracy and completeness.
7. Submit the form to the appropriate insurance company or benefits manager as specified in the instructions.
8. Keep a copy of the submitted form and any correspondence for your records.

Who needs Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

1. Patients diagnosed with thrombocytopenia due to chemotherapy or other medical conditions who require Neumega® (oprelvekin) for treatment.
2. Healthcare providers prescribing Neumega® who need to obtain authorization for the medication from insurance companies.

People Also Ask about

What is oprelvekin approved for?

It was approved for adult patients with non-myeloid cancers for chemotherapy-related thrombocytopenia based on studies confirming the drug's efficacy in patients who had experienced severe thrombocytopenia following chemotherapy.

Is oprelvekin FDA approved?

The drug is formulated in single-use vials containing 5 mg of oprelvekin (specific activity approximately 8 million units/mg) as a sterile, lyophilized powder. The FDA approved the drug in 1997.

Is Oprelvekin available in the USA?

Oprelvekin has caused allergic or hypersensitivity reactions, including anaphylaxis. Permanently discontinue administration of oprelvekin in any patient who develops an allergic or hypersensitivity reaction. Note: Neumega has been discontinued in the US for more than 1 year.

Can oprelvekin cause hepatotoxicity?

In multiple controlled trials, interleukin 11 was not found to cause elevations in serum enzymes or episodes of clinically apparent liver injury. Furthermore, no specific instances of hepatitis or jaundice have been reported in the literature and liver injury is not listed as an adverse event in the product label.

What is the drug oprelvekin used for?

A drug used to increase the number of blood cells, especially platelets, in some cancer patients receiving chemotherapy. Oprelvekin is a form of interleukin-11 (a cytokine normally made by support cells in the bone marrow) that is made in the laboratory.

Is oprelvekin used for thrombocytopenia?

Oprelvekin has thrombopoietic activity and has been licensed to prevent severe thrombocytopenia and reduce the need for platelet transfusion after myelosuppressive chemotherapy (1). Common adverse effects included myalgia and arthralgias, fatigue, headache, and conjunctival injection.

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What is Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

The Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form is a document required by healthcare providers to obtain approval from insurance companies before prescribing Neumega® for patients. It ensures that the medication is covered and deemed medically necessary.

Who is required to file Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

Healthcare providers, such as doctors or clinics, are required to file the Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form on behalf of their patients to secure insurance approval for the medication.

How to fill out Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

To fill out the Neumega® (oprelvekin) PAB Form, providers need to complete sections that include patient's personal information, medical history, diagnosis, treatment plan, and any supporting documents that explain the need for the medication.

What is the purpose of Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

The purpose of the Neumega® (oprelvekin) PAB Form is to obtain necessary prior authorization from insurance providers to confirm coverage for the medication, ensuring that patients have access to the treatment they need.

What information must be reported on Neumega® (oprelvekin) Prior Authorization of Benefits (PAB) Form?

The information that must be reported on the Neumega® (oprelvekin) PAB Form includes patient demographics, prescriber information, clinical diagnosis, treatment history, justification for the need for Neumega®, and any relevant medical records.