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PHARMACY COVERAGE GUIDELINES
SECTION:
DRUGSORIGINAL EFFECTIVE DATE:
LAST REVIEW DATE:
LAST CRITERIA REVISION DATE:
ARCHIVE DATE:11/19/15
11/16/17
11/16/17ERIVEDGE (vismodegib) oral capsule
Coverage
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How to fill out erivedge - blue cross
How to fill out erivedge - blue cross
01
To fill out Erivedge - Blue Cross, follow the steps below:
02
Obtain the Erivedge - Blue Cross form from your healthcare provider or insurance company.
03
Review the form and make sure you understand all the sections and requirements.
04
Provide your personal information accurately, including your full name, address, date of birth, and contact details.
05
Fill in your insurance information, including your Blue Cross policy number and group ID if applicable.
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Provide details about your medical condition and the need for Erivedge medication.
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Attach any supporting documents or medical reports that may be required by Blue Cross.
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Submit the filled-out form to Blue Cross through the designated submission method, whether it's online, mail, or fax.
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Please note that these instructions are general and may vary depending on the specific requirements of your Blue Cross plan. It is always recommended to consult the instructions provided with the form or contact Blue Cross directly for any clarifications.
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Erivedge - Blue Cross is typically needed by individuals who meet the following criteria:
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- Individuals diagnosed with locally advanced basal cell carcinoma (BCC) that cannot be treated with surgery or radiation.
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It is important to note that the specific coverage and eligibility criteria for Erivedge - Blue Cross may vary depending on the Blue Cross plan. To determine if you are eligible for coverage, it is recommended to review your insurance policy or consult with Blue Cross directly.
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What is erivedge - blue cross?
Erivedge - Blue Cross is a medication used to treat certain types of cancer.
Who is required to file erivedge - blue cross?
Medical professionals and healthcare providers are required to file erivedge - blue cross for their patients.
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The purpose of erivedge - blue cross is to ensure proper documentation and reimbursement for the medication used in cancer treatment.
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Information such as patient demographics, diagnosis, treatment plan, and medication dosage must be reported on erivedge - blue cross.
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