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PRIOR AUTHORIZATION PROGRAM REIMBURSEMENT REQUEST FORM For rare diseases: Saliva (obeticholic acid)Please fax form to: 18668401509Please note that the patient AND physician must complete this form.
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01
To fill out for rare diseases Ocaliva, follow these steps:
02
Consult with your healthcare provider or specialist about your rare disease and the use of Ocaliva.
03
Obtain a prescription for Ocaliva from your healthcare provider.
04
Research the specific guidelines and requirements for obtaining Ocaliva for your rare disease in your country or region.
05
Contact your insurance provider to determine if Ocaliva is covered under your insurance plan.
06
Complete any necessary paperwork or forms required by your healthcare provider, insurance company, or pharmacy.
07
Submit the completed forms and prescription to your pharmacy.
08
Await approval and processing of your prescription by the pharmacy and/or insurance company.
09
Once approved, follow the instructions provided by your healthcare provider for taking Ocaliva.
10
Monitor and track your progress while taking Ocaliva and communicate any changes or concerns with your healthcare provider.
11
Follow up with your healthcare provider on a regular basis to assess the effectiveness and safety of Ocaliva for your rare disease.

Who needs for rare diseases ocaliva?

01
Ocaliva is generally prescribed for individuals with certain rare diseases, including:
02
- Primary biliary cholangitis (PBC)
03
- Nonalcoholic steatohepatitis (NASH)
04
- Primary sclerosing cholangitis (PSC)
05
It is important to consult with a healthcare provider or specialist to determine if Ocaliva is appropriate for your specific rare disease condition.
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