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

Revlimid

(lenalidomide)

Revlimid 2.5 MG Oral CapsuleRevlimid 5 MG Oral Capsule

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Dosage & administration

* MM combination therapy: 25 mg once daily orally on Days 1-21 of repeated 28-day cycles. .
* MM maintenance therapy following auto-HSCT: 10 mg once daily continuously on Days 1-28 of repeated 28-day cycles .
* MDS: 10 mg once daily .
* MCL: 25 mg once daily orally on Days 1-21 of repeated 28-day cycles .
* FL or MZL: 20 mg once daily orally on Days 1-21 of repeated 28-day cycles for up to 12 cycles .
* Renal impairment: Adjust starting dose based on the creatinine clearance value .
* For concomitant therapy doses, see Full Prescribing Information .

drug label

Revlimid prescribing information

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prior authorization

Revlimid prior authorization resources

Most recent Revlimid prior authorization forms

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Verified: Apr 03, 2024Kaiser Permanente - Mid Atlantic States HMO Revlimid Prior Authorization Form Maryland/Virginia/Washington DC

Verified: Apr 02, 2024Kaiser Permanente - Maryland Health Choice Revlimid Prior Authorization Form Maryland

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

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

Coverage Authorization Appeals

Commercial Claim Denial Appeal/Redetermination Letter*

Medically Unlikely Edit (MUE) Appeal Letter

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Benefits investigation

Revlimid Enrollment Form

Revlimid Enrollment Form - Spanish

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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pharmacy

Revlimid preferred pharmacy

Pharmacy List

Financial Assistance

Financial Assistance Programs

Revlimid retails for $878 per dose without insurance or financial assistance.Depending on your patient's insurance situation and other eligibility criteria, they may be able to get Revlimid for significantly less. Review the program information below to determine what program can offer your patient the most benefits.

CoPay Card Program$0 Co Pay

Available for

commercial

Program Details

Program Expires Calendar Year

Forms

Revlimid Enrollment Form

Revlimid Enrollment Form - Spanish

PubMed™ | Revlimid

Revlimid PubMed™ News

patient education

Revlimid patient education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link