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ETEPLIRSEN (EXODUS 51) PRESCRIBER ORDER FORM Fax completed form, insurance information, and clinical documentation to: (410) 5586439 Patient Name:Date of Birth:Address: Phone:Height:Clinical Information

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How to fill out pshp - eteplirsen exondys

01

Step 1: Gather all necessary information and documents including patient information, prescription details, and insurance information.

02

Step 2: Download the PSHCP form for Eteplirsen (Exondys).

03

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Step 5: Submit the completed form according to the instructions provided.

Who needs pshp - eteplirsen exondys?

01

Patients with Duchenne muscular dystrophy who have a confirmed mutation amenable to exon 51 skipping and who have been prescribed Eteplirsen (Exondys) by their healthcare provider.

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What is pshp - eteplirsen exondys?

The pshp - eteplirsen exondys is a postmarketing safety surveillance program for the drug Exondys, also known as eteplirsen.

Who is required to file pshp - eteplirsen exondys?

Healthcare providers who prescribe Exondys are required to file the pshp - eteplirsen exondys.

How to fill out pshp - eteplirsen exondys?

The pshp - eteplirsen exondys can be filled out online through a designated portal or by submitting paper forms to the appropriate regulatory authorities.

What is the purpose of pshp - eteplirsen exondys?

The purpose of the pshp - eteplirsen exondys is to monitor and evaluate the safety and effectiveness of Exondys in real-world clinical settings.

What information must be reported on pshp - eteplirsen exondys?

Information such as adverse events, patient outcomes, and drug utilization must be reported on the pshp - eteplirsen exondys.

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