Läkemedelsföretagen tvekar ofta inför att satsa på ny antibiotika för att det inte är tillräckligt lönsamt, men de ska nu ges ekonomiska morötter köpa inderal receptfritt Ofta fås en bättre/snabbare absorption när läkemedel tas på fastande mage men för vissa läkemedel är det önskvärt att minska risken för biverkningar från mag-tarmkanalen genom att läkemedlet tas tillsammans med föda.
Microsoft word - smoking cessation pa form npi july 11.doc
Quitline Iowa FAX Completed Form To 1-800-784-8669 1-866-688-7577 Iowa Department of Public Health/Quitline Iowa REQUEST FOR PRIOR AUTHORIZATION Smoking Cessation Therapy- Oral
(PLEASE PRINT - ACCURACY IS IMPORTANT)
Member ID #: |___|___|___|___|___|___|___|___|___| Patient Name: ___________________________________ DOB: _________________
Patient Address:__________________________________________________________________________________________________
Provider NPI: |___|___|___|___|___|___|___|___|___|___| Prescriber Name:_______________________________ Phone:_________________ Prescriber Address:_______________________________________________________________________ Fax:____________________ Pharmacy Name:_____________________________ Address:_______________________________________ Phone:_________________ Prescriber must fill all information above. It must be legible, correct and complete or form will be returned. Pharmacy NPI: |___|___|___|___|___|___|___|___|___|___| Pharmacy Fax: _____________________ NDC : |___|___|___|___|___|___|___|___|___|___|___| Prior Authorization is required for varenicline (Chantix™) or bupropion SR that is FDA approved for smoking cessation. Requests for authorization must include: 1) Diagnosis of nicotine dependence and referral to the Quitline Iowa program for counseling. 2) Confirmation of enrollment and ongoing participation in the Quitline Iowa counseling program is required for approval and continued coverage. 3) Approvals will only be granted for patients eighteen years of age and older. 4) The duration of therapy is initially limited to twelve weeks within a twelve-month period. For patients who have successfully stopped smoking at the end of 12 weeks, an additional course of 12 weeks treatment will be considered with a prior authorization request. The maximum duration of approvable therapy is 24 weeks within a twelve-month period. 5) Requests for varenicline to be used in combination with bupropion SR or nicotine replacement therapy will not be approved. 6) The 72-hour emergency supply rule does not apply for drugs used for the treatment ofsmoking cessation
Chantix™ Starter Pak Chantix™ 1mg BID Other: _______________________ (**May check more than one box**)
Bupropion SR Strength_____________ Dosing Instructions:__________________________________________________ PA Renewal Prescriber signature on this line indicates medical documentation that the member has stopped smoking after the initial 12 weeks of therapy. _______________________________
The patient has agreed to the following:
1) Volunteered to participate with Quitline Iowa
2) Quitline Iowa may contact the patient about quitting smoking, local programs, and/or counseling
3) Quitline Iowa may discuss the patient’s use of Quitline with the patient’s health care provider and/or Iowa Medicaid
4) All the patient’s information will be kept private
________________________________________ ________________ _________________ _____________ Patient’s Signature Patient’s Phone Number Preferred Language Hearing Impaired/Need TDD Best times and days for Quitline to call: 8:00 a.m. to noon
Best days to call:_________________________
The counselor may leave a message saying
Prescriber Signature: _________________________________________ Date of Submission: ______________________ *MUST MATCH PRESCRIBER LISTED ABOVE
Prescriber: Please fax completed portion above to Quitline Iowa: 1-866-688-7577. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ Outcome (to be completed by Quitline Iowa and faxed to the Iowa Medicaid PA Department at 1-800-574-2515):
Member enrolled in Quitline Iowa Counseling Program
IMPORTANT NOTE: In evaluating requests for prior authorization the consultant will consider the treatment from the standpoint of medical necessity only. If approval of this request is granted, this does not indicate that the member continues to be eligible for Medicaid. It is the responsibility of the provider who initiates the request for prior authorization to establish by inspection of the member’s Medicaid eligibility card and, if necessary by contact with the county Department of Human Services, that the member continues to be eligible for Medicaid.
Pulsional Revista de Psicanálise Pulsional Revista de Psicanálise , ano XIII, no 131, 38-41 Escuta-se freqüentemente dizer que, na crise da meia-idade, os homens podem atravessar um período em que seu desejo pela companheira parece amolecerou, em todo caso, não mais se levantar como antes. Em geral, eles se inquietame começam a duvidar da própria capacidade. Nos Estados Unidos, fala
Assaying Bacterial Survival In vivo Working protocol from Eleanor R. Haine, Department of Animal and Plant Sciences. University of Sheffield, Western Bank, Sheffield, S10 2TN. [email protected] Overview: This assay measures how quickly insects can clear pathogens from their haemolymph. Each insect is challenged with a dose of antibiotic resistant bacteria. At regular time-intervals