Serostim Statement Of Medical Necessity

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View, download and print Serostim Pa 04-26-06 - Prescriber's Statement Of Medical Necessity - Serostim For Treatment Of Aids Wasting Syndrome - Patient Information pdf template or form online. 8 Maryland Medicaid Application Form Templates are collected for any of your needs. Serostim is a human growth hormone that is used to treat children and adults who does not have the sufficient natural growth hormone in their bodies. Lack of this hormone can result in children and adults being short due to Prader-Willi syndrome, Noonan syndrome, and Turner syndrome. This medication works by enhancing the low levels of growth . Doctor first needs to send statement of medical necessity form, and patient must first go through to the insurance verification program. Then an application will be sent out. . they will receive an application to be completed. Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more than once every 21 days . SEROSTIM is produced by a mammalian cell line (mouse C127) that has been modified by the addition of the hGH gene. SEROSTIM is secreted directly through the cell membrane into the cell-culture medium for collection and purification. SEROSTIM is a sterile lyophilized powder intended for subcutaneous injection after reconstitution to its liquid form. Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form. Application is sent to Patient's home. Patient and Doctor will be notified in writing within 5-7 business days. . they will receive an application to be completed. Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more . STATEMENT OF MEDICAL NECESSITY Phone: 1-877-714-AXIS (2947) Fax: 866-823-9554 Pharmacy Name Pharmacy Address Pharmacy Fax Complete and fax. Note that some plans may require 3-6 months of clinical notes. Make sure to complete entire form before submitting. Register Only PATIENT INFORMATION 3. PRESCRIBER INFOSEROSTIM is produced by a mammalian cell line (mouse C127) that has been modified by the addition of the hGH gene. SEROSTIM is secreted directly through the cell membrane into the cell-culture medium for collection and purification. SEROSTIM is a sterile lyophilized powder intended for subcutaneous injection after reconstitution to its liquid form. Sogroya ® (somapacitan-beco) injection 5 mg, 10 mg or 15 mg is a prescription medicine that contains human growth hormone, the same growth hormone made by the body. It is given by injection under the skin (subcutaneous) and is used to treat adults and children 2. 5 years and older who do not make enough growth hormone. Stop therapy. I certify that this treatment is medically necessary and meets the FDA-approved Serostim® labeled use guidelines. Supporting documentation in the patient's medical record is available for State audits. You should not take Serostim® if you have: A critical illness from surgery, serious injuries, or a severe breathing problem Cancer or undergoing treatment for cancer Eye problems caused by diabetes Allergies to growth hormone or other ingredients in Serostim® vials What is the most important information I need to know about Serostim®? For patients with critical … Important Safety . How Serostim® Works Materials to help further your discussions about HIV‑associated wasting, Serostim treatment, and medication access. Help your patients understand HIV‑associated wasting, Serostim treatment, and the steps needed to inject their medication. Medically reviewed by Drugs. com. Last updated on Feb 2, 2022. SEROSTIM is administered by subcutaneous injection. SEROSTIM therapy should be carried out under the regular guidance of a physician who is experienced in the diagnosis and management of HIV infection. HIV-associated wasting or cachexiaMedicare defines "medical necessity" as services or items reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. CMS has the power under the Social Security Act to determine, on a case-by-case basis, if the method of treating a patient is reasonable and necessary. Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight. Shortness of breath, a big weight gain, or swelling in the arms or legs. Chest pain or pressure or a fast heartbeat. Sweating a lot. Depression or other mood changes. Serostim ® is a recombinant human growth hormone. It is the only FDA approved treatment proven to treat the 3 key symptoms of HIV‑associated wasting by increasing LBM and body weight and improving physical endurance. What Is HIV‑associated Wasting?Seek prompt medical attention if you have an allergic reaction while taking Serostim ®. You may have swelling, especially in the hands and feet, as well as discomfort in bones, joints, and muscles. This may lessen with analgesics or talk to your doctor about reducing Serostim ® dosing frequency. Serostim® (somatropin) for injection Official Patient SiteDoctor/Doctor's office starts process by filling out Statement of Medical Necessity Form. Application is sent to Patient's home. Patient and Doctor will be notified in writing within 5-7 business days. . they will receive an application to be completed. Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more . Headache, nausea, vomiting, tiredness, muscle pain, or weakness may occur. If these symptoms continue or become bothersome, inform your doctor or pharmacist promptly. Remember that this medication . Medically reviewed by Drugs. com. Last updated on Jan 12, 2023. Uses Before taking Dosage Warnings Side effects Uses for Serostim Somatropin injection is a man-made version of human growth hormone. Growth hormone is naturally produced by the pituitary gland and is necessary to stimulate growth in children. pain, itching, or skin changes where the medicine was injected; swelling, rapid weight gain; muscle or joint pain; numbness or tingling; stomach pain, gas; headache, back pain; or. cold or flu . Before taking Dosage Interactions What is Serostim? Serostim is a form of human growth hormone important for the growth of bones and muscles. Serostim is also used in adults to treat short bowel syndrome, or to prevent severe weight loss related to AIDS. Serostim may also be used for purposes not listed in this medication guide. Serostim ® . 2. 2 . Preparation and Administration . Each vial of Serostim. 5 mg or 6 mg is reconstituted with 0. 5 to 1 mL Sterile Water for Injection, USP. Each vial of Serostim 4 mg is reconstituted in 0. 5 to 1 mL of Bacteriostatic Water for Injection, USP (0. 9% Benzyl Alcohol preserved). For patients sensitive to Benzyl Alcohol, Serostim may be

1. https://colab.research.google.com/drive/1cQgyCSXJTngI8e8VDA4GY0dVFYnIYfvE


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3. https://groups.google.com/g/39beefer93/c/CVhk7PeliQE


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5. https://groups.google.com/g/88muscleman82/c/mCAnkoJJHSU

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