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Revlimid Patient Physician Agreement Form

yang April 11, 2021     No Comment     Uncategorized

yang

Whether you`re a patient, caregiver or family member, download a REVLIMID conversation starter to find out how you can talk to your doctor and others about multiple myeloma. To avoid embryo-fetal exposure, revlimid is only available through a limited distribution program called REVLIMID Risk Evaluation and Mitigation Strategy (REMS) ® program. The REMS® REVLIMID program requires that prescribing professionals and pharmacies be certified and that patients register and meet all program requirements. For each of your subsequent REVLIMID recipes, you need to follow a similar process. For more information on the needs of the RevLIMID REMS program, see www.CelgeneRiskManagement.com or in the patient manual on the REMS REVLIMID program. Depending on your patient`s insurance situation, there are programs and organizations that can help pay REVLIMID. 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 process or open REVLIMID capsules® (lenalidomide) Use this chart and your calendar to track your doctor, your most important data and information. A possible birth defect (deformed baby) or the death of an unborn baby. Women who are pregnant or wish to be pregnant should not take REVLIMID. To register with yourself and your patients for more information and to download forms on the REVLIMID REMS program®, please visit CelgeneRiskManagement.com.

For patients with commercial or private insurance (including health exchanges), the co-payment of REVLIMID is reduced to $25 (subject to the annual limit). Revlimid may be available free of charge to qualified patients who are uninsured or underinsured.† Email us at patientsupport@celgene.com or fax 1-800-822-2496. For patients who can`t afford their medications (including patients with Medicare, Medicaid or other state-subsidized insurance), independent third-party organizations may be able to help. To avoid serious risks to unborn babies, REVLIMID is only available through a limited distribution program called REVLIMID Risk Evaluation and Mitigation Strategy (REMS). The specialist pharmacy will contact you to advise you on the serious risks and safety conditions of REVLIMID before receiving your prescription. You also coordinate the delivery of REVLIMID to you If you are able to become pregnant, you must perform a first pregnancy test within 10-14 days before receiving a REVLIMID prescription. REVLIMID comes to their address with a medication guide. A signature is required to receive this shipment Your doctor will send your prescription to a specialty pharmacy.

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