Injectafer form
WebbCheck Request Form. This form is used by the office in the event there is an issue with the processing of the Injectafer ® Savings Program financial card. Check request form. All documentation can also be mailed to: 100 Passaic Ave, Suite 245, Fairfield, NJ 07004. WebbHow to request precertifications and prior authorizations for patients. Depending on a patient's plan, you may be required to request a prior authorization or precertification for any number of prescriptions or services. A full list of CPT codes are available on the CignaforHCP portal . For Medical Services Description of service
Injectafer form
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WebbFor patients weighing lessthan 50kg (110lb): Give Injectafer in two doses separated by at least 7 days and give each dose as 15 mg/kg body weight. Injectafertreatment may be repeated if iron deficiency anemia r eoccurs. (2) -----DOSAGE FORMS AND STRENGTHS-----Injection: 750 mg iron / 15 mLsingle-dose vial.(3) WebbList of the names, pharmaceutical forms, strengths of the medicinal products, routes of administration, marketing authorisation holders in the Member States . 2 . Member State ... Injectafer . 50.00 mg/ml . Solution for injection/infusion . Intravenous use . Bulgaria . VIFOR France SA 7-13 Boulevard Paul Emile Victor 92521 Neuilly-sur-Seine France
WebbPrior Authorization Request Form Please complete this entire form and fax it to: 866-940-7328. If you have questions, please call 800-310-6826. This form may contain multiple pages. Please complete all pages to avoid a delay in our decision. Allow at least 24 hours for review. Member Information Prescriber Information Member Name: Provider Name ... WebbInjectafer is contraindicated in patients with hypersensitivity to Injectafer or any of its inactive components. Warnings and Precautions Symptomatic hypophosphatemia requiring clinical intervention has been reported in patients at risk of low serum phosphate in the postmarketing setting.
WebbThe NDC code 0517-0620 is assigned by the FDA to the product Injectafer which is a human prescription drug product labeled by American Regent, Inc.. The generic name of Injectafer is ferric carboxymaltose. The product's dosage form is injection, solution and is administered via intravenous form. The product is distributed in a single package ... Webb5 apr. 2024 · Injectafer contains the active drug ferric carboxymaltose, which is an iron replacement product. It comes as a solution that your doctor will inject into your vein. Your doctor may administer...
Webb• Complete all required fields • Print the form • Obtain patient signature • Fax the following to 1-888-257-4673: The EOB provided must include the name of the insurance company, date of service, product name/J-code, and patient responsibility amount. DAIICHI SANKYO ACCESS CENTRAL 1-866-4-DSI-NOW (1-866-437-4669)
WebbFor patients weighing less than 50 kg (110 lb): Give Injectafer in two doses separated by at least 7 days and give each dose as 15 mg/kg body weight. Injectafer treatment may be repeated if iron deficiency anemia reoccurs. (2) -----DOSAGE FORMS AND STRENGTHS----- Injection: 750 mg iron / 15 mL single-dose vial. (3) blacked out houseWebbInjectafer is injected into your vein to treat iron deficiency anemia in adults and pediatric patients 1 year of age and older. Injectafer should be used only if you have not responded well to treatment with oral iron, or if you are intolerant to oral iron treatment. It is also used to treat iron deficiency anemia in adults with chronic kidney ... gamecube softwareWebbFor pharmacy drugs, prescribers can submit their requests to Humana Clinical Pharmacy Review (HCPR) — Puerto Rico through the following methods: Phone requests: 1-866-488-5991. Hours: 8 a.m. to 6 p.m. local time, Monday through Friday. Fax requests: Complete the applicable form below and fax it to 1-855-681-8650. gamecube sonic gamesWebb3 DOSAGE FORMS AND STRENGTHS . Injection: 50 mg/mL, dark brown, non -transparent, sterile, aqueous solution. • 750 mg iron/15 mL single -dose vial • 1,000 mg iron/20 mL single -dose vial . 4 CONTRAINDICATIONS . Injectafer is contraindicated in patients with a history of hypersensitivity to Injectafer or any of its components gamecube sortieWebbLa substance active est le fer (sous forme de carboxymaltose ferrique, un composé glucidique de fer). La concentration de fer présent dans le médicament est de 50 mg par millilitre. Les autres composants sont l’hydroxyde de sodium (pour ajustement du pH), l’acide chlorhydrique (pour ajustement du pH) et l’eau pour préparations ... gamecube soccer gamesWebb8 jan. 2024 · Ferric carboxymaltose is an iron replacement therapy used to treat iron deficiency anemia in children and adults with intolerance or inadequate clinical response to oral iron, and in adult patients who have non-dialysis dependent chronic kidney disease. Brand Names Injectafer Generic Name Ferric carboxymaltose DrugBank Accession … blacked out hoodieWebb26 juli 2013 · Injectafer® is a parenteral iron replacement product used for the treatment of iron deficiency anemia (IDA) in adult patients who have intolerance to oral iron or have had an unsatisfactory response to oral iron. Injectafer® is also indicated for iron deficiency anemia in adult patients with non-dialysis dependent chronic kidney disease (NND-CKD). gamecube sonic mega collection