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PRIOR AUTHORIZATION FORM Firdapse Medicare Unless otherwise indicated below, authorization quantities are limited to the manufacturer recommended dosageComplete online at www.selecthealth.org/pa or
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How to fill out firdapse - medicare
How to fill out firdapse - medicare
01
Contact your healthcare provider or pharmacy to obtain a prescription for Firdapse
02
Check with your insurance provider to ensure coverage under Medicare
03
Fill out Medicare Part D form or other necessary paperwork provided by your insurance
04
Submit the paperwork along with your prescription to the pharmacy for processing
Who needs firdapse - medicare?
01
Patients with Lambert-Eaton myasthenic syndrome (LEMS) who have a Medicare plan
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What is firdapse - medicare?
Firdapse is a medication used to treat Lambert-Eaton myasthenic syndrome (LEMS), a rare autoimmune disorder that affects communication between nerves and muscles. Medicare provides coverage for Firdapse under certain conditions.
Who is required to file firdapse - medicare?
Patients who are prescribed Firdapse and wish to have their medication covered by Medicare may need to file for coverage depending on their specific Medicare plan.
How to fill out firdapse - medicare?
Patients should follow the specific instructions provided by their healthcare provider and Medicare plan for filing for Firdapse coverage. This typically involves completing a request for prior authorization or coverage determination.
What is the purpose of firdapse - medicare?
The purpose is to ensure that patients with LEMS have access to necessary medication through Medicare coverage, thus reducing their out-of-pocket costs.
What information must be reported on firdapse - medicare?
Essential information includes patient identification, specific diagnosis, prescribed medication details, dosage, and physician information.
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