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PRIOR AUTHORIZATION REQUEST FORMOcaliva Medicare Phone: 2159914300Fax back to: 8663713239Health Partners Plans manages the pharmacy drug benefit for your patient. Certain requests for coverage require
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01
Obtain the prescribed dosage and instructions from your healthcare provider.
02
Take Ocaliva at the same time each day, with or without food.
03
Swallow the tablet whole with a glass of water.
04
Do not crush, chew, or break the tablet.
05
Follow up with your healthcare provider regularly to monitor progress and adjust dosage if needed.

Who needs ocaliva - health partners?

01
Individuals diagnosed with primary biliary cholangitis (PBC) who have not responded to other treatments.
02
Health partners looking to provide an alternative treatment option for PBC patients.
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Ocaliva (obeticholic acid) is a medication used to treat primary biliary cholangitis, a chronic liver disease, in combination with other treatments.
Patients prescribed Ocaliva and their healthcare providers are typically required to file certain healthcare documentation and insurance claims related to the treatment.
To fill out Ocaliva-related documentation, patients should follow the instructions provided by their healthcare provider or insurance company, ensuring that all required information is accurately completed.
The purpose of Ocaliva - health partners is to provide necessary information and documentation related to the treatment and management of patients receiving Ocaliva for their medical conditions.
Information reported may include patient medical history, prescription details, treatment plans, and other relevant health information as required by health partners or insurance providers.
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