COVID-19: We remain open for your care. We are taking every precaution to ensure your safety.

COVID-19: We remain open for your care. We are taking every precaution to ensure your safety.

Ilumya

Ilumya (tildrakizumab – asmn) [ Sun Pharma ]

  • Plaque Psoriasis
    • 100mg SC at 0 and 4 weeks, then SQ q 12 weeks.
  • Need patient weight, Hep B S Ag, PPD or QuantiFERON

Instructions

  1. Please open authorization forms at left. Fill out the forms on your computer, save and print.
  2. Open Physician Orders for the office of your choice (at left). Save to your computer, print and fill out.
  3. The following tests should be performed and test results faxed to Pacific Infusion before the patient’s first visit:
  4. Tildrakizumab – CXR, PPD
  5. Fax the following to Pacific Infusion Center (310) 297-9222:
    • Completed and signed forms/order
    • Copy of the patient’s insurance card(s)
    • Demographics
    • OV notes
    • Tried and failed medications
    • Labs
    • Drug Enrollment Forms
  6. After the patient’s infusion appointment, one of our nurses will fax a copy of the infusion notes to your office.

Actemra (tocilizumab) [Genentech]

  • Rheumatoid Arthritis (IV)
    • 4mg/kg every 4 weeks up to 8mg/kg every 4 weeks
  • Rheumatoid Arthritis (SC)
    • Pt less than 100kg: 162mg every other week, up to every week
    • Pt at or above 100kg: 162mg every week
  • Giant Cell Arteritis
    • 162mg SC q week, in combination with tapering corticosteroids
  • Can be used with or without methotrexate
  • Need patient weight, PPD or QuantiFERON test, Hep B S Ag, Hep C Ab, LFTs, CBC

 

Instructions

  1. Please open authorization forms at left. Fill out the forms on your computer, save and print.
  2. Open Physician Orders for the office of your choice (at left). Save to your computer, print and fill out.
  3. The following tests should be performed and test results faxed to Pacific Infusion before the patient’s first visit:
    Actemra – Patient’s current weight, CXR, PPD
  4. Fax the completed, signed forms and a copy of the patient’s insurance card to: Pacific Infusion Center (310) 297-9222.
  5. After the patient’s infusion appointment, one of our nurses will fax a copy of the infusion notes to your office.