Dosing and
Administration Guide

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Instructions for Use

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Medication Guide

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Prescribing Information

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Coverage Support/KevzaraConnect® Resources

Coverage Support/KevzaraConnect® Resources

Enrollment
Form

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The KevzaraConnect Enrollment Form is designed to be easily completed by you and your patients. Once the entire enrollment form is completed and signed by you and your patient, fax pages 1 through 4 to 1-844-538-8960.

Sample Letter Template:
Medical Necessity

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KEVZARA sample letters are included to help provide the type of information that may be useful when responding to a health plan. These letters provide an example of the types of information that may be provided when responding to a request from a patient’s health plan to provide either a letter of appeal or a letter of medical necessity for KEVZARA. Use of the information in these letters does not guarantee that the health plan will cover KEVZARA and is not intended to be a substitute for or an influence on the independent medical judgment of the physician.

Sample Letter
Template: Appeals

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KEVZARA sample letters are included to help provide the type of information that may be useful when responding to a health plan. These letters provide an example of the types of information that may be provided when responding to a request from a patient’s health plan to provide either a letter of appeal or a letter of medical necessity for KEVZARA. Use of the information in these letters does not guarantee that the health plan will cover KEVZARA and is not intended to be a substitute for or an influence on the independent medical judgment of the physician.