Benlysta

Benlysta (Belimumab) 

Glaxo Smith Kline

• Systemic Lupus Erythematosus (IV)

ㅤㅤㅤ• 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter

ㅤㅤㅤ• No ancillary tests needed

Instructions

1 – Please open authorization forms (above). Fill out the forms on your computer, save and print.

2 – Open Physician Orders for the office of your choice (above). Save to your computer, print and fill out.

3 – Fax the following to Pacific Infusion Center (310) 297-9222:

ㅤ• Completed and signed forms/order

ㅤ• Copy of the patient’s insurance card(s)

ㅤ• Demographics

ㅤ• OV notes

ㅤ• Tried and failed medications

ㅤ• Labs

ㅤ• Drug Enrollment Forms

4 – After the patient’s infusion appointment, our nurses will fax a copy of the infusion notes to your office.