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PRIOR AUTHORIZATION PROGRAM REIMBURSEMENT REQUEST FORM
For rare disease therapy: Carmelo (telotristat ethyl)Please fax form to:
18668401509Please note that the patient AND physician must complete
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How to fill out xermelo telotristat ethyl
How to fill out xermelo telotristat ethyl
01
Read the medication guide and instructions provided by your healthcare professional before starting treatment with Xermelo (telotristat ethyl).
02
Take Xermelo exactly as prescribed by your doctor. Follow the dosing schedule and instructions carefully.
03
Xermelo is usually taken orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush, chew, or break the tablet.
04
The recommended dose of Xermelo is 250 mg taken three times daily with food.
05
Take Xermelo at the same times each day to help you remember.
Who needs xermelo telotristat ethyl?
01
Xermelo (telotristat ethyl) is prescribed for adult patients with carcinoid syndrome diarrhea that is inadequately controlled by somatostatin analog (SSA) therapy alone.
02
It is used in combination with SSA therapy to reduce the frequency of diarrhea in patients with metastatic neuroendocrine tumors (NETs) and to improve overall quality of life.
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What is xermelo telotristat ethyl?
Xermelo telotristat ethyl is a medication used to treat carcinoid syndrome diarrhea in adults.
Who is required to file xermelo telotristat ethyl?
Xermelo telotristat ethyl is typically prescribed by healthcare providers who are treating patients with carcinoid syndrome diarrhea.
How to fill out xermelo telotristat ethyl?
Xermelo telotristat ethyl is usually taken orally as prescribed by a healthcare provider. It is important to follow the instructions provided with the medication.
What is the purpose of xermelo telotristat ethyl?
The purpose of xermelo telotristat ethyl is to reduce the frequency of diarrhea in patients with carcinoid syndrome.
What information must be reported on xermelo telotristat ethyl?
Information such as dosage, frequency of administration, and any side effects experienced should be reported to the prescribing healthcare provider.
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