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Healthcare Professionals

Patient Consent and HCP Authorization

If your Patient Support Specialist has instructed you to submit a consent or authorization form, please select from the options below. Please note, the form will not appear until you have made your selection.

 

Once your form has appeared:

  1. Fill in the requested information
  2. Read and sign the form
  3. Click Submit

If you would like a copy of your completed form, please contact your Patient Support Specialist.

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REVLIMID® (lenalidomide) and POMALYST® (pomalidomide) are only available through restricted distribution programs.

Please see full Prescribing Information, including Boxed WARNINGS, for REVLIMID®, POMALYST®, IDHIFA® (enasidenib), INREBIC® (fedratinib), and ABRAXANE® for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound). Please see full prescribing information for REBLOZYL® (luspatercept-aamt).

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The ICD-10-CM Codes provided here are for diagnoses reasonably related to an indication or indications within the product’s approved label and are provided for your reference only. Other codes may be appropriate. Celgene makes no representation that any code is appropriate for a particular patient. Healthcare Professionals must use their independent judgment in selecting Code(s) to accurately reflect the diagnosis of the specific patient.

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Carol
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Celgene Patient Support® Specialist
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Carol
Carol is the Celgene Patient Support® Specialist for Zip Code .

If this is not your doctor's zip code, click the zip code link above.

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