Celgene Patient Physician Agreement Form

By on April 8, 2021.

The prescriber/patient completes a mandatory confidential survey for patients who cannot afford their medications (including patients with Medicare, Medicaid or other state-subsidized insurance) and independent third-party organizations may be able to help. Celgene Patient Support® can also provide information on insurance coverage or other programs that you can check for prescription negative pregnancy test for all female patients with reproductive potential. The certified pharmacy advises the patient and closes the checklist for education and advice from Two negative pregnancy tests must be performed before the start of treatment. The first test should be performed within 10 to 14 days and the second within 24 hours of the prescription of pomalyst, then weekly in the first month, and then every month after in women with regular menstrual cycles or every 2 weeks in women with irregular menstrual cycles. Email us at patientsupport@celgene.com or fax 1-800-822-2496. Your specialist can provide you with information about independent third-party organizations† that can help you pay your fees: the prescriber receives an authorization number from Celgene and writes it on each prescription, along with the patient`s risk category Depending on your patient`s insurance situation, there are programs and organizations that can help pay REVLIMID. The prescriber completes a patient-patient® (lenalidomide) agreement form with each patient and sends it to Celgene The certified pharmacy donates REVLIMID to the patient with a medication guide Your doctor will advise you on why you and your partner should prevent your pregnancy. Your doctor will also advise you not to share the medication, not to donate blood or semen, and to use appropriate contraception. You should be advised not to use extensively or open POMALYST® (Pomalidomide) capsules For each of your subsequent recipes, you must follow a similar process.

For more information on the needs of the Pomalyst program ®, see www.CelgeneRiskManagement.com or in the patient manual on the POMALYST REMS program®.