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Prescriber Criteria Form Avail 2023 PA Fax 3495A v1 010123.docx Avail (avapritinib) Coverage Determination This fax machine is located in a secure location as required by HIPAA regulations. Complete/review

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Patients who have been prescribed Ayvakit (avapritinib) and need to provide information about their prior treatment history may need to fill out the prior authorization form.

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What is ayvakit avapritinib - prior?

Ayvakit avapritinib - prior is a form that needs to be filed prior to starting treatment with the medication Ayvakit (avapritinib) for certain medical conditions.

Who is required to file ayvakit avapritinib - prior?

Healthcare providers are required to file the ayvakit avapritinib - prior form before prescribing Ayvakit (avapritinib) to their patients.

How to fill out ayvakit avapritinib - prior?

The ayvakit avapritinib - prior form can usually be filled out electronically through an online platform provided by the healthcare institution or manually by completing a paper form with the required information.

What is the purpose of ayvakit avapritinib - prior?

The purpose of ayvakit avapritinib - prior is to ensure that patients are appropriately screened and monitored before starting treatment with Ayvakit (avapritinib) in order to minimize potential risks and maximize benefits.

What information must be reported on ayvakit avapritinib - prior?

The ayvakit avapritinib - prior form typically requires information such as patient medical history, current medications, relevant lab results, and any known allergies or contraindications.

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