№ lp_2_3_54851
File format: docx
Character count: 7868
File size: 26 KB
Year:
2023
Region / city:
Not specified
Subject:
Medical necessity of dual biologic therapy for hidradenitis suppurativa
Document type:
Medical letter
Organization / institution:
Not specified
Author:
Dermatologist
Target audience:
Insurance providers, healthcare professionals
Effective period:
Not specified
Approval date:
Not specified
Amendment date:
Not specified
Context:
Medical letter advocating for insurance approval of dual biologic therapy for a patient with severe hidradenitis suppurativa, citing clinical data and treatment history.
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Year:
2023
Region / City:
Australia
Topic:
Hidradenitis Suppurativa Treatment
Document Type:
Submission for Pharmaceutical Benefits Scheme (PBS) Listing
Organ / Institution:
Novartis Pharmaceuticals Australia Pty Limited
Author:
Novartis Pharmaceuticals Australia Pty Limited
Target Audience:
Medical professionals, Healthcare policymakers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Category / Program:
General Schedule (Code GE)
Prescriber Type:
Dental Medical Practitioners, Nurse Practitioners, Optometrists, Midwives
Restriction Type:
Authority Required
Severity:
Moderate to severe
Condition:
Hidradenitis suppurativa
Treatment Phase:
Initial treatment
Clinical Criteria:
Hurley stage II or III grading, abscess and inflammatory nodule count ≥ 3, failure to respond to antibiotics
Treatment Criteria:
Dermatologist supervision
Population Criteria:
Adult patients
Administrative Advice:
Subcutaneous injection
Prescribing Instructions:
Must assess disease severity, first 4 weeks under restriction
Cost:
$6,145.10 for 300 mg/2 mL pre-filled syringe/pen
Source:
Table 1.1, p25; Table 1.6, p35; Table 1.7, pp36-37; Table 1.7, p38
Year:
2021
Region / City:
Slough, UK
Topic:
Immunology, Dermatology
Document Type:
Research Article
Organization / Institution:
UCB
Author:
Joseph Rastrick, Hannah Edwards, Alex S. Ferecskó, Gaëlle Le Friec, Avneet Manghera, Matthew Page, Stevan Shaw
Target Audience:
Researchers, Healthcare Professionals
Period of Validity:
Not specified
Date of Approval:
Not specified
Date of Changes:
Not specified
Context:
The document is a research article presenting findings on the roles of IL-17A and IL-17F in hidradenitis suppurativa (HS), based on human in vitro and clinical experiments.
Year:
2023
Region / City:
Australia
Topic:
Hidradenitis Suppurativa Treatment
Document Type:
Submission for Pharmaceutical Benefits Scheme (PBS) Listing
Organ / Institution:
Novartis Pharmaceuticals Australia Pty Limited
Author:
Novartis Pharmaceuticals Australia Pty Limited
Target Audience:
Medical professionals, Healthcare policymakers
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Amendments:
Not specified
Category / Program:
General Schedule (Code GE)
Prescriber Type:
Dental Medical Practitioners, Nurse Practitioners, Optometrists, Midwives
Restriction Type:
Authority Required
Severity:
Moderate to severe
Condition:
Hidradenitis suppurativa
Treatment Phase:
Initial treatment
Clinical Criteria:
Hurley stage II or III grading, abscess and inflammatory nodule count ≥ 3, failure to respond to antibiotics
Treatment Criteria:
Dermatologist supervision
Population Criteria:
Adult patients
Administrative Advice:
Subcutaneous injection
Prescribing Instructions:
Must assess disease severity, first 4 weeks under restriction
Cost:
$6,145.10 for 300 mg/2 mL pre-filled syringe/pen
Source:
Table 1.1, p25; Table 1.6, p35; Table 1.7, pp36-37; Table 1.7, p38
Year:
2021
Region / City:
Slough, UK
Topic:
Immunology, Dermatology
Document Type:
Research Article
Organization / Institution:
UCB
Author:
Joseph Rastrick, Hannah Edwards, Alex S. Ferecskó, Gaëlle Le Friec, Avneet Manghera, Matthew Page, Stevan Shaw
Target Audience:
Researchers, Healthcare Professionals
Period of Validity:
Not specified
Date of Approval:
Not specified
Date of Changes:
Not specified
Context:
The document is a research article presenting findings on the roles of IL-17A and IL-17F in hidradenitis suppurativa (HS), based on human in vitro and clinical experiments.
Note:
Year
Theme:
Medical Equipment, Adaptive Devices
Document Type:
Medical Necessity Letter
Target Audience:
Insurance Providers, Medical Professionals
Organization:
Driscoll Health Plan
Document type:
Clinical policy and administrative guidelines
Revision date:
November 1, 2024
Geographic scope:
Texas
Programs referenced:
STAR, STAR Kids, CHIP
Subject area:
Therapy services prior authorization and medical necessity
Target audience:
Therapy providers and referring physicians
Authorization method:
Provider web portal and fax submission
Related forms:
Texas Standard Prior Authorization Request Form for Health Care Services (TARF), Therapy Referral Review by Ordering Physician Attestation Form
Effective policy elements:
Initial evaluations, re-evaluations, continuation of therapy, start of care rules
Coverage criteria:
Medical necessity based on clinical documentation
Source type:
Health plan policy guideline
Year:
2021
Region / City:
United States
Topic:
Medical Necessity Letter, Health Treatment
Document Type:
Medical Document
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Medical professionals, healthcare providers
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2021
Region / City:
California, Arizona
Topic:
Energy Transmission, Public Utilities
Document Type:
Decision
Organization / Institution:
California Public Utilities Commission
Author:
California Public Utilities Commission
Target Audience:
Stakeholders in energy infrastructure and transmission
Effective Period:
N/A
Approval Date:
November 4, 2021
Date of Changes:
N/A
Year:
2025
Region / City:
United States
Theme:
Medical necessity letter
Document type:
Medical letter
Organization / Institution:
Takeda Pharmaceuticals U.S.A., Inc.
Author:
Takeda Pharmaceuticals U.S.A., Inc.
Target audience:
Physicians, insurance providers
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Note:
Date
Diagnosis:
G36.0, neuromyelitis optica [Devic]
Treatment:
UPLIZNA® (inebilizumab-cdon), injection, 1 mg
Reason for request:
Medical necessity for treatment of neuromyelitis optica spectrum disorder (NMOSD) with UPLIZNA
Enclosures:
Prescribing Information, clinical notes, FDA approval letter, patient relapse history, test results, etc.
Year:
2024
Region / City:
United States
Topic:
Medical Necessity Letter
Document Type:
Medical Letter
Organization / Institution:
Bausch + Lomb
Author:
Physician
Target Audience:
Healthcare providers, Payers
Action Period:
June 2024
Approval Date:
June 2024
Modification Date:
N/A
Document type:
Medical necessity letter
Therapeutic area:
Ophthalmology
Indication:
Reduction of intraocular pressure in open-angle glaucoma or ocular hypertension
Medication name:
VYZULTA (latanoprostene bunod ophthalmic solution)
Dosage strength:
0.024%
Drug class:
Prostaglandin analogue with nitric oxide–donating activity
Regulatory status:
FDA-approved prescription medication
Manufacturer:
Bausch & Lomb Inc.
Intended recipient:
Health insurance payer or medical director
Target population:
Patients with open-angle glaucoma or ocular hypertension
Clinical evidence referenced:
Phase 2 VOYAGER study; Phase 3 APOLLO and LUNAR studies; real-world retrospective studies
Safety information included:
Yes
References:
Peer-reviewed journals and prescribing information
Source type:
Industry-provided informational material
Year:
2025
Region / City:
Princeton, NJ
Theme:
Medical necessity documentation
Document Type:
Medical letter
Organization / Institution:
Bristol-Myers Squibb Company
Author:
<>
Target Audience:
Healthcare professionals, physicians
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2025
Jurisdiction:
West Virginia, United States
Type of document:
Legislative Act
Governing body:
West Virginia Legislature
Authors:
Delegates Riley, Linville, D. Cannon, Eldridge
Effective date:
April 11, 2025
Subject:
Public utilities regulation, water and sewer services, certificate of public convenience and necessity
Legal references:
§24-2-11, §31-15A-1 et seq. of the West Virginia Code
Scope:
Construction projects of water and sewer services for utilities with at least 4,500 customers and $3 million or more in annual revenues
Approval authority:
Public Service Commission, Infrastructure and Jobs Development Council
Decision timelines:
Standard projects 225–270 days, projects >$50 million 400 days
Year:
2023
Region / City:
United States
Subject:
Healthcare
Document Type:
Template
Institution / Organization:
Takeda Oncology
Author:
Takeda Oncology
Target Audience:
Healthcare providers, insurance companies
Effective Period:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Note:
Date
Year:
2026
Region / City:
N/A
Topic:
Genetic Testing, Exome Sequencing
Document Type:
Letter
Organization / Institution:
N/A
Author:
N/A
Target Audience:
Healthcare providers, medical practitioners
Validity Period:
N/A
Approval Date:
N/A
Modification Date:
N/A
Program:
Illinois Early Intervention Program
State:
Illinois
Type of document:
Administrative form
Subject area:
Early intervention services
Focus:
Assistive technology justification
Target population:
Infants and toddlers enrolled in Early Intervention
Associated plan:
Individualized Family Service Plan (IFSP)
Required contributors:
Early Intervention evaluator, service coordinator, physician
Required approvals:
Physician signature
Content sections:
Demographic information, provider information, IFSP details, assessment and justification
Purpose:
Documentation of developmental necessity for assistive technology items
Note:
Year
Topic:
Medical Nutrition
Document Type:
Template Letter
Organization / Institution:
Abbott Nutrition
Author:
Physician
Target Audience:
Health Insurance Providers