Get the free PDF Kalydeco (ivacaftor) - Prior Authorization Form ... - Aetna Better Health
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Aetna Better Health of Texas Medicaid/CHIP Texas Standard Prior Authorization Form Addendum Zydeco (ivacaftor) / Rabbi (lumacaftor/ivacaftor)In addition to the Texas Standard Prior Authorization Request
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Who needs pdf kalydeco ivacaftor?
01
Kalydeco (Ivacaftor) is a medication prescribed for individuals with specific gene mutations that cause cystic fibrosis.
02
Those who have the following gene mutations may need Kalydeco (Ivacaftor):
03
- G551D
04
- G1244E
05
- G1349D
06
- G178R
07
- G551S
08
- S1251N
09
- S1255P
10
- S549N
11
It is important to consult with a healthcare professional to determine if Kalydeco (Ivacaftor) is suitable and necessary for an individual's specific condition.
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What is pdf kalydeco ivacaftor?
Pdf Kalydeco Ivacaftor is a medication used to treat cystic fibrosis in patients with a specific genetic mutation.
Who is required to file pdf kalydeco ivacaftor?
Healthcare providers are required to file pdf Kalydeco Ivacaftor for patients prescribed with the medication.
How to fill out pdf kalydeco ivacaftor?
Pdf Kalydeco Ivacaftor can be filled out by providing the necessary patient information, dosage details, and relevant medical history.
What is the purpose of pdf kalydeco ivacaftor?
The purpose of pdf Kalydeco Ivacaftor is to monitor the use and effectiveness of the medication in treating cystic fibrosis.
What information must be reported on pdf kalydeco ivacaftor?
Pdf Kalydeco Ivacaftor must include patient details, prescription details, dosage information, and any side effects experienced.
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