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Carmelo (Telotristat Ethyl)
Prior Authorization Request Form
Caterpillar Prescription Drug Benefit
Phone: 8772287909 Fax: 8004247640
Instructions: Please fill out all applicable sections completely
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02
Wash your hands with soap and water.
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Take out the xermelo telotristat ethyl package from the box.
04
Open the package and remove the blister pack containing the tablets.
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Pop out the tablet from the blister pack. Make sure not to break or damage the tablet.
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Place the tablet on your tongue and let it dissolve. Do not chew or swallow the tablet whole.
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After the tablet dissolves, drink a glass of water to wash it down.
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Repeat the process for each dose as instructed by your doctor.
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Close the package tightly and store it in a cool, dry place.
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Note: It is important to follow your doctor's instructions and read the medication guide provided with xermelo telotristat ethyl for detailed instructions.
Who needs xermelo telotristat ethyl?
01
Xermelo telotristat ethyl is a prescription medication used to treat adults with carcinoid syndrome diarrhea that is not adequately controlled by somatostatin analog (SSA) therapy alone.
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People who have been diagnosed with carcinoid syndrome and experience frequent diarrhea may be candidates for xermelo telotristat ethyl.
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However, it is important to consult with a healthcare professional to determine if xermelo telotristat ethyl is appropriate for your specific condition.
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What is xermelo telotristat ethyl?
Xermelo (telotristat ethyl) is a medication used to treat adult patients with diarrhea caused by neuroendocrine tumors.
Who is required to file xermelo telotristat ethyl?
Patients prescribed Xermelo and their healthcare providers are required to file necessary documentation related to its use.
How to fill out xermelo telotristat ethyl?
Patients should follow the prescription guidelines provided by their healthcare provider, including dosage and administration instructions.
What is the purpose of xermelo telotristat ethyl?
The purpose of Xermelo is to reduce diarrhea in patients with carcinoid syndrome associated with neuroendocrine tumors.
What information must be reported on xermelo telotristat ethyl?
Reports must include patient identification, treatment details, dosage, and any observed side effects.
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