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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HLTH5476
for the current year.
Form HLTH5476 Special Authority Request - Velpatasvir Plus Sofosbuvir With or Without Ribavirin (Rbv) for Chronic Hepatitis C - British Columbia, Canada
Form HLTH5476 Special Authority Request - Velpatasvir Plus Sofosbuvir With or Without Ribavirin (Rbv) for Chronic Hepatitis C in British Columbia, Canada is used to request special authority for the prescription medication Velpatasvir Plus Sofosbuvir, with or without Ribavirin, for the treatment of chronic hepatitis C. It is specific to the healthcare system in British Columbia, Canada.
The Form HLTH5476 Special Authority Request - Velpatasvir Plus Sofosbuvir With or Without Ribavirin (Rbv) for Chronic Hepatitis C in British Columbia, Canada is filed by healthcare providers or physicians.
FAQ
Q: What is HLTH5476 Special Authority Request?A: HLTH5476 Special Authority Request is a form used in British Columbia, Canada to request coverage for the medication Velpatasvir Plus Sofosbuvir with or without Ribavirin (Rbv) for the treatment of Chronic Hepatitis C.
Q: What is Velpatasvir Plus Sofosbuvir?A: Velpatasvir Plus Sofosbuvir is a combination medication used to treat Chronic Hepatitis C. It contains the antiviral drugs Velpatasvir and Sofosbuvir.
Q: What is Ribavirin?A: Ribavirin is an antiviral medication that is sometimes used in combination with Velpatasvir Plus Sofosbuvir for the treatment of Chronic Hepatitis C.
Q: Who can use this form?A: This form is for residents of British Columbia, Canada who are seeking coverage for Velpatasvir Plus Sofosbuvir with or without Ribavirin (Rbv) for the treatment of Chronic Hepatitis C.
Q: What is Chronic Hepatitis C?A: Chronic Hepatitis C is a viral infection of the liver that can cause long-term liver damage if left untreated.
Q: What is Special Authority?A: Special Authority is a process in British Columbia, Canada where coverage for certain medications is requested on a case-by-case basis. This form is used to request Special Authority for Velpatasvir Plus Sofosbuvir with or without Ribavirin (Rbv) for the treatment of Chronic Hepatitis C.
Download Form HLTH5476 Special Authority Request - Velpatasvir Plus Sofosbuvir With or Without Ribavirin (Rbv) for Chronic Hepatitis C - British Columbia, Canada
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