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Prior AuthorizationFCHP (MEDICAID) Demist Step Therapy (CHP) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed
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How to fill out harvoni - fallon health

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To fill out Harvoni - Fallon Health, follow these steps:
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Obtain the Harvoni medication from your healthcare provider or pharmacy.
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Read the instructions provided with the medication carefully.
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Take the prescribed dosage as instructed by your healthcare provider.
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Make sure to take Harvoni with food.
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Who needs harvoni - fallon health?

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Harvoni - Fallon Health is typically prescribed for individuals who have been diagnosed with chronic hepatitis C virus (HCV) infection.
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Specifically, individuals who meet the following criteria may need Harvoni - Fallon Health:
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- Adults with chronic HCV infection, including those with compensated cirrhosis (Child-Pugh A)
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- Individuals without liver cirrhosis or with mild liver cirrhosis (Child-Pugh A)
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- Patients without severe renal impairment (eGFR ≥30 mL/min/1.73 m²)
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- Individuals who have not received prior treatment for HCV infection or who have not responded to previous HCV treatment.
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However, it is important to consult with a healthcare professional to determine if Harvoni - Fallon Health is the appropriate treatment option for you.
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Harvoni is a prescription medication used to treat chronic hepatitis C virus (HCV) infection. Fallon Health is a health insurance provider that may cover the costs associated with Harvoni treatment for its members.
Patients who are receiving Harvoni treatment and wish to have their medication costs covered by Fallon Health must file the necessary documentation with the insurance provider.
To fill out the necessary forms for Harvoni coverage under Fallon Health, patients should obtain the required forms from their healthcare provider or Fallon Health's website, complete them with accurate personal and medical information, and submit them as directed.
The purpose of Harvoni is to provide an effective antiviral treatment for chronic hepatitis C. The involvement of Fallon Health is to ensure that patients have access to necessary medications and treatment coverage.
Patients must report personal identification information, medical history, specific details about their hepatitis C diagnosis, and any other relevant information as required by Fallon Health forms.
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