Ilumya (tildrakizumab – asmn)

Sun Pharma
  • Plaque Psoriasis
    • 100mg SC at 0 and 4 weeks, then every q 12 weeks.
  • Need PPD or QuantiFERON



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 – The following tests should be performed and test results faxed to Pacific Infusion before the patient’s first visit: PPD, QuantiFERON, or Ilumya (Tildrakizumab)

4 – 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

5 – After the patient’s infusion appointment, our nurses will fax a copy of the infusion notes to your offic,