VUMERITY Prescription Guidance and Patient Support
This document provides detailed instructions for healthcare providers on prescribing VUMERITY, including patient consent protocol and important safety information. It also outlines how patients can get started and enroll in Biogen Support Services. Important contact details and resource links are provided for further assistance.
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How do I fill this out?
To fill out this form, start by ensuring that you have discussed VUMERITY with your patient. Next, assist your patient in completing the Patient Consent Information section and the Start Form. Finally, ensure the completed Start Form is sent via fax to the appropriate pharmacy.
How to fill out the VUMERITY Prescription Guidance and Patient Support?
1
Discuss VUMERITY with your patient.
2
Complete the Patient Consent Information section.
3
Fill out the Start Form together with your patient.
4
Fax the completed Start Form to the designated number.
5
Ensure all sections of the form are complete to avoid delays.
Who needs the VUMERITY Prescription Guidance and Patient Support?
1
Healthcare providers requiring guidance on VUMERITY prescriptions.
2
Patients seeking information on how to enroll in Biogen Support Services.
3
Pharmacies needing to understand the process for handling VUMERITY prescriptions.
4
Insurance companies needing documentation for patient coverage.
5
Clinical coordinators managing patient follow-ups and medication adherence.
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What are the instructions for submitting this form?
To submit this form, fax the completed Start Form to 1-855-474-3067. You can also provide your patient’s information via phone at 1-800-456-2255 for questions. Ensure all fields are filled out correctly to avoid delays in processing and obtaining support services.
What are the important dates for this form in 2024 and 2025?
There are no specific important dates listed for this form in 2024 and 2025. However, it's advisable to stay informed through Biogen for any updates or changes to these instructions as new guidelines may emerge.
What is the purpose of this form?
The purpose of this form is to provide a comprehensive guideline for healthcare providers when prescribing VUMERITY. It assists in ensuring proper patient enrollment in Biogen programs and promotes informed consent. Moreover, this document aims to facilitate communication between patients, healthcare providers, and Biogen for a smooth treatment initiation.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Consent Information: Section for patients to review and consent to share information.
- 2. Start Form: Form to be filled out by healthcare providers and patients to begin the support process.
What happens if I fail to submit this form?
Failure to submit this form could delay the patient's access to VUMERITY and associated support services. It is crucial for timely processing to avoid disruption in treatment.
- Delays in Treatment: Patients may experience delays starting their medication if the form is incomplete.
- Loss of Support Services: Patients may miss out on Biogen’s support programs and financial assistance.
How do I know when to use this form?
- 1. Prescribing VUMERITY: When a healthcare provider decides to prescribe this medication.
- 2. Patient Enrollment: When patients need to sign up for support services related to VUMERITY treatment.
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Is there a limit on how many times I can edit this PDF?
There are no limits on editing; you can make changes as many times as you need.
How can I stay updated on VUMERITY?
Provide your email address when filling out the Start Form to receive updates directly.
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If you encounter any issues, please reach out to our support for assistance.
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Once your edits are complete, simply click the download button to save the PDF.
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