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CONTAINS CONFIDENTIAL PATIENT INFORMATION (clostridium histolyticum) Prior Authorization of Benefits (PAB) Form Complete form in its entirety and fax to: Prior Authorization of Benefits Center at
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Who Needs Clostridium Histolyticum:
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Individuals with Dupuytren's contracture: Clostridium Histolyticum is primarily used in the treatment of Dupuytren's contracture, a condition characterized by the thickening and tightening of connective tissues in the hands. It is prescribed to patients who experience functional limitations due to the contractures.
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Patients who have not responded to non-surgical treatments: Clostridium Histolyticum is often prescribed to patients who have not responded well to non-surgical treatments such as physical therapy or steroid injections. It is considered as an alternative when conservative measures do not provide sufficient relief.
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Adults with suitable hand conditions: This medication is intended for use in adult patients who have suitable hand conditions presenting with a palpable cord. It is important to consult with a healthcare professional to determine if Clostridium Histolyticum is appropriate for your specific condition.
Remember, it is essential to consult with a healthcare professional before starting any new medication, including Clostridium Histolyticum. They can provide guidance tailored to your individual needs and help ensure the safe and effective use of this treatment.
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