Letter of medical necessity
A letter of medical necessity is a letter written by the patient’s treating physician to the patient’s insurance company requesting prior approval for medication or reconsideration of a denial. The letter should generally contain information on the patient’s medical history and current treatment plan. You can download guidelines for writing a letter of medical necessity here.
Appointment of representative release form
The appointment of representative release form is often required by insurance companies in the event of an appeal. This form allows Celgene Patient Support® to assist the patient with the appeals process. You can download the form here.
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), and ABRAXANE® for Injectable Suspension (paclitaxel protein-bound particles for injectable suspension) (albumin-bound).
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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.