Empliciti

(elotuzumab)
Empliciti 300 MG InjectionEmpliciti 400 MG Injection
NO BLACK BOX WARNING

Dosage & administration

biomarker testing

Empliciti clinical details

Genetic testing requirements were obtained from the NCCN guidelines for each cancer type.

drug label

Empliciti prescribing information

prior authorization

Empliciti prior authorization resources

Most recent Empliciti prior authorization forms

View By Payer
Updated: May 30, 2023Cigna - Empliciti Prior Authorization Form
Updated: May 24, 2023Aetna - Empliciti Prior Authorization Form
Updated: May 23, 2023Aetna - Medicare Part B Empliciti Prior Authorization Form

PDF
Complete Letter of Medical Necessity

PDF
Coverage Authorization Appeals

PDF
Commercial Claim Denial Appeal/Redetermination Letter

PDF
Medically Unlikely Edit (MUE) Appeal Letter
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Benefits investigation

PDF
Empliciti Enrollment Form

PDF
Empliciti Enrollment Form - Spanish
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Reimbursement help (FRM)

OTHER
Receive Assistance from an FRM Regarding Reimbursement Information
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financial assistance

Empliciti financial assistance options

Co-pay savings program

commercial only

PDF
Empliciti Enrollment Form

PDF
Empliciti Enrollment Form - Spanish

OTHER
Enroll in Patient Savings Program
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Foundation programs

under insured
no insurance
goverment insurance
65+

PDF
Empliciti Enrollment Form

PDF
Empliciti Enrollment Form - Spanish
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patient education

Empliciti patient education

Getting started on Empliciti

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

BRAND PAGE
About Empliciti
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Learn More

Other resources

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people also ask

Empliciti FAQs

How is the dosage of Empliciti?Empliciti is available in 2 dosages, including 300 mg Injection and 400 mg Injection
What does Empliciti treat?Empliciti treats Multiple Myeloma
What is Empliciti made of?Empliciti contains elotuzumab which is a SLAMF7-directed Immunostimulatory Antibody
How Is Empliciti Administered?Empliciti is administered as a Injectable
What Are The Empliciti Mechanism Of Action?Empliciti mechanism of action is SLAMF7-directed Antibody Interactions
FAQ Data Source