Dosage & Administration Drug label Prior authorization Pharmacy Financial assistance PubMed™ News

Koselugo

(selumetinib)

Koselugo 10 MG Oral CapsuleKoselugo 25 MG Oral Capsule

NO BOXED WARNING

Dosage & administration

* The recommended dosage is 25 mg/m2 taken orally twice daily on an empty stomach. Do not consume food 2 hours before each dose or 1 hour after each dose.
* Reduce the recommended dosage to 20 mg/m2 orally twice daily for patients with moderate hepatic impairment (Child-Pugh B). The recommended dosage for use in patients with severe hepatic impairment (Child-Pugh C) has not been established.

drug label

Koselugo prescribing information

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prior authorization

Koselugo prior authorization resources

Most recent Koselugo prior authorization forms

View By Payer

Verified: Apr 07, 2024Kaiser Foundation Health Plan - Chronic High-Dose Opioid Therapy Prior Authorization Form Washington

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Medicare Prescription Drug Medication Request Form

Verified: Apr 01, 2024Highmark BCBS Northeastern NY - Short Acting Opioid Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Specialty Drug Prior Authorization Form

Verified: Apr 01, 2024Highmark BCBS Western NY - Non-Formulary Drug Coverage Prior Authorization Form

Most recent state uniform prior authorization forms

Verified: Mar 28, 2024Arizona - Uniform Prior Authorization Form

Verified: Mar 28, 2024Colorado - Uniform Prior Authorization Form

Verified: Mar 28, 2024Hawaii - Uniform Prior Authorization Form

Verified: Mar 28, 2024Illinois - Uniform Prior Authorization Form

Verified: Mar 28, 2024Indiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Louisiana - Uniform Prior Authorization Form

Verified: Mar 28, 2024Minnesota - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Mar 28, 2024New Mexico - Uniform Prior Authorization Form

Verified: Mar 28, 2024Oregon - Uniform Prior Authorization Form

Verified: Mar 28, 2024Texas - Uniform Prior Authorization Form

Complete Letter of Medical Necessity

Prior Authorization Criteria

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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pharmacy

Koselugo preferred pharmacy

Pharmacy List

financial assistance

Koselugo financial assistance options

Co-pay savings program

commercial only

Enroll in Patient Savings Program

Learn More

Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

PubMed™ | Koselugo

Koselugo PubMed™ News

patient education

Koselugo patient education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link