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Prescriber Criteria Formally Health Medicare Previous 2019 PA Fax C12479A FHC v1 120118.docx Previous (letermovir) Coverage Determination This fax machine is located in a secure location as required
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Prevymis Letermovir - Prior is typically needed by individuals who have been prescribed this medication by their healthcare professional for the prevention or treatment of cytomegalovirus (CMV) infection.
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What is prevymis letermovir - prior?
Prevymis (letermovir) is an antiviral medication used primarily for the prevention of cytomegalovirus (CMV) infection in at-risk patients, such as those undergoing stem cell transplants.
Who is required to file prevymis letermovir - prior?
Healthcare providers and institutions administering Prevymis may need to file prior authorization requests to ensure coverage by insurance companies for the medication.
How to fill out prevymis letermovir - prior?
To fill out a prior authorization for Prevymis, include patient demographics, diagnosis, treatment history, and the specific reason for prescribing the medication along with any supporting clinical documentation.
What is the purpose of prevymis letermovir - prior?
The purpose of the prior authorization is to obtain approval from the insurance provider for coverage of the medication, demonstrating medical necessity for the treatment.
What information must be reported on prevymis letermovir - prior?
Required information typically includes patient information, clinical details, previous treatments, dosage prescribed, and the rationale for using Prevymis over alternative therapies.
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