Transcription of Stelara® (ustekinumab) Specialty Medication ...
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Stelara® (ustekinumab) Specialty Medication ...
Stelara ( ustekinumab ) Specialty aetna precertification Notification Phone: 1-855-240-0535. Medication precertification request FAX: 1-877-269-9916. Page 1 of 3 For Medicare Advantage Part B: (Please return Pages 1 to 3 for precertification of medications.) FAX: 1-844-268-7263. Please indicate: Start of treatment: Start date / /. Continuation of therapy: Date of last treatment / /. precertification Requested By: Phone: Fax: A. PATIENT INFORMATION. First Name: Last Name: DOB: Address: City: State: ZIP: Home Phone: Work Phone: Cell Phone: Email: Current Weight: lbs or kgs Height: inches or cms Allergies: B.
Stelara® (ustekinumab) Specialty Medication Precertification Request Page 3 of 3 (Please return Pages 1 to 3 for precertification of medications.) Aetna Precertification Notification
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