Form HLTH5821 Pharmacare Special Authority Request - Siponimod (Mayzent) for Secondary Progressive Multiple Sclerosis - British Columbia, Canada

Form HLTH5821 Pharmacare Special Authority Request - Siponimod (Mayzent) for Secondary Progressive Multiple Sclerosis in British Columbia, Canada is for requesting coverage for the medication Siponimod (brand name Mayzent) specifically for individuals with Secondary Progressive Multiple Sclerosis. This form is used to apply for special authority to receive this medication through the Pharmacare program in British Columbia.

The Form HLTH5821 Pharmacare Special Authority Request - Siponimod (Mayzent) for Secondary Progressive Multiple Sclerosis in British Columbia, Canada is typically filed by the prescribing healthcare professional or their staff on behalf of the patient.

FAQ

Q: What is the purpose of the HLTH5821 Pharmacare Special Authority Request?A: The purpose of the HLTH5821 Pharmacare Special Authority Request is to request coverage for the medication Siponimod (Mayzent) for the treatment of Secondary Progressive Multiple Sclerosis in British Columbia, Canada.

Q: What is Siponimod (Mayzent) used for?A: Siponimod (Mayzent) is used for the treatment of Secondary Progressive Multiple Sclerosis.

Q: What is the HLTH5821 form?A: The HLTH5821 form is the Pharmacare Special Authority Request form specifically designed for requesting coverage of Siponimod (Mayzent) for Secondary Progressive Multiple Sclerosis in British Columbia, Canada.

Q: Who is eligible to request coverage through the HLTH5821 form?A: Patients with Secondary Progressive Multiple Sclerosis in British Columbia, Canada are eligible to request coverage through the HLTH5821 form.