Omvoh (Mirikizumab-mrkz)

Omvoh (Mirikizumab-mrkz)

LILLY

  • Ulcerative Colitis 

                o 300 mg IV at Weeks 0, 4, and 8 

                o Need patient weight, QuantiFERON, CMP

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

4 – 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

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