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This form is used to request prior authorization for the administration of Casgevy (exagamglogene autotemcel) in beneficiaries, following specific guidelines outlined for treatment of sickle cell disease and transfusion-dependent β-thalassemia. It requires comprehensive beneficiary, prescriber, and diagnosis information along with necessary documentation.
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What is casgevy prior authorization form?
The Casgevy prior authorization form is a document required by healthcare providers to obtain approval from insurance companies before prescribing certain medications or treatments.
Who is required to file casgevy prior authorization form?
Healthcare providers, including physicians and other licensed practitioners, are required to file the Casgevy prior authorization form when they need approval for specific treatments or medications on behalf of their patients.
How to fill out casgevy prior authorization form?
To fill out the Casgevy prior authorization form, the healthcare provider must provide patient information, the specific treatment or medication being requested, supporting medical documentation, and any relevant patient history.
What is the purpose of casgevy prior authorization form?
The purpose of the Casgevy prior authorization form is to ensure that the prescribed treatments or medications are medically necessary and covered by the patient's insurance plan before proceeding.
What information must be reported on casgevy prior authorization form?
The Casgevy prior authorization form must report patient demographics, insurance information, specific medication or treatment requested, clinical details supporting the request, and any previous treatment attempts.
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