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A simple patient referral process.

Click the therapy below, and follow the three steps.

IVX Health primarily administers specialty biologic infusions and injections for those with complex chronic conditions. IVX Health updates its formulary on a consistent basis. To inquire about a specific therapy not listed below, please contact us.

Please include the following information when submitting a referral for Actemra:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active rheumatoid arthritis (RA) who has had an inadequate response to one or more disease modifying anti-rheumatic drugs (DMARDs)
    • Patient has giant cell arteritis (GCA)
    • Patient has active polyarticular juvenile idiopathic arthritis
    • Patient has active systemic juvenile idiopathic arthritis
Please include the following information when submitting a referral for Aduhelm:
  • Brain MRI within one year before starting treatment
    The patient will be required to complete three MRIs at different stages of the ADUHELM therapy regimen. The first must be completed before therapy starts, and the next MRIs must be completed after the sixth and eleventh infusion. IVX Health does not order or administer these MRIs. Patients must work with their referring physician to complete these diagnostic tests.
  • Cognitive test showing patient has reached the clinical stages for Alzheimer’s disease defined as mild cognitive impairment or mild dementia
    Patients must receive a cognitive test showing mild cognitive impairment or mild dementia prior to receiving ADUHELM at IVX Health Patients should work with their referring physician to complete this diagnostic test.
  • Confirmation of Amyloid Beta Pathology – either in the form of an Amyloid Beta Pet Scan or through Cerebral Spinal Fluid (CSF) biomarker testing
    Biogen is providing CSF biomarker test at no charge to patients through LabCorp and Mayo Clinic. The Amyloid βeta Confirmed™ program is being offered to help improve patient access to CSF biomarker testing to help support timely and accurate diagnosis of AD.
Please include the following information when submitting a referral for Aralast NP:
  • Clinical information that supports the diagnosis of adults with clinically evident emphysema due to severe hereditary deficiency of Alpha1-PI (alpha1-antitrypsin deficiency)
Please include the following information when submitting a referral for Benlysta:
  • Clinicals to support that the patient has active, autoantibody-positive, systemic lupus erythematosus (SLE) and is receiving standard therapy
Please include the following information when submitting a referral for Cerezyme:
  • Clinicals to support one or more of the following:
    • Type 1 Gaucher disease that results in one or more of the following conditions; anemia, throbocytopenia, bone disease, hepatomegaly or splenomegaly.
Please include the following information when submitting a referral for Cimzia:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Patient's current weight and height
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active rheumatoid arthritis (RA)
    • Patient has active psoriatic arthritis
    • Patient has active ankylosing spondylitis
    • Patient has active moderately to severely Crohn's disease who has had an inadequate response to conventional therapy
    • Patient has moderate to severe plaque psoriasis (PSO) who is a candidate for systemic therapy or phototherapy
Please include the following information when submitting a referral for Cinqair:
  • Lab results showing elevated eosinophil levels
  • List of current medications treating severe asthma
  • Patient has severe asthma with an eosinophilic phenotype and is 18 years of age or older
  • FEV1 test results
Please include the following information when submitting a referral for Crysvita:
  • Clinicals to support one or more of the following:
    • Patient has X-linked hypophosphatemia (XLH)
    • Patient is 6 months of age or older
Please include the following information when submitting a referral for Elaprase:
  • Office notes with presence of clinical signs and symptoms of the disease and Molecular genetic testing for deletion or mutations in the iduronate 2-sulfatase gene
Please include the following information when submitting a referral for Entyvio:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Patient's current weight and height
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active Crohn’s disease (CD)
    • Patient has moderately to severely active ulcerative colitis (UC)
Please include the following information when submitting a referral for Fabrazyme:
  • Clinicals to support that the patient has Fabry disease
Please include the following information when submitting a referral for Fasenra:
  • List of current medications treating disease
  • Lab results showing eosinophil count
  • Clinicals showing number of asthma exacerbations in the last 12 months
  • Clinicals showing that the patient has severe asthma and has an eosinophilic phenotype
  • FEV1 test results
Please include the following information when submitting a referral for Feraheme:
  • Most recent labs results
  • Patient has iron deficiency anemia
Please include the following information when submitting a referral for Glassia:
  • Clinical information that supports the diagnosis of adults with clinically evident emphysema due to severe hereditary deficiency of Alpha1-PI (alpha1-antitrypsin deficiency)
Please include the following information when submitting a referral for Ilaris:
  • Office notes with presence of clinical signs and symptoms of the disease
  • Result of Tuberculosis (TB) skin/ lab testing
Please include the following information when submitting a referral for Ilumya:
  • Clinicals to support one or more of the following:
    • Moderate-to-severe plaque psoriasis
When submitting a referral for IVIG, please include clinical documentation to support a diagnosis for the following indications:
Gammagard Liquid
Indications:
  • GAMMAGARD LIQUID is an immune globulin infusion (human) indicated as replacement therapy for primary humoral immunodeficiency (PI) in adult and pediatric patients two years of age or older.
  • GAMMAGARD LIQUID is indicated as a maintenance therapy to improve muscle strength and disability in adult patients with Multifocal Motor Neuropathy.

Gammaked
Indications:
  • Primary Humoral Immunodeficiency (PI) in patients 2 years of age and older.
  • Idiopathic Thrombocytopenic Purpura (ITP) in adults and children.
  • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in adults.

Octagam
Indications:
  • Octagam is an immune globulin intravenous (human), 5% liquid, indicated for treatment of primary humoral immunodeficiency (PI)
  • Chronic immune thrombocytopenic purpura (ITP) in adults.
  • Dermatomyositis (DM) in adults.

Asceniv
Indications:
  • Indicated for the treatment of primary humoral immunodeficiency (PI) in adults and adolescents (12 to 17 years of age)

Bivigam
Indications:
  • Indicated for the treatment of primary humoral immunodeficiency

Gammagard S-D 5%
Indications:
  • Treatment of Primary Immunodeficiency (PI) in adults and pediatric patients two years of age or older
  • Prevention and/or control of bleeding in adult Chronic Idiopathic Thrombocytopenic Purpura (ITP) patients

NOTE: For almost all of the IVIG therapies it is recommend to monitor renal function in patents at risk of acute renal failure.

Please include the following information when submitting a referral for Krystexxa:
  • Perform serum uric acid (sUA) test prior to each infusion
  • Screen patients at risk for G6PD deficiency prior to starting therapy
  • Patient had chronic gout and is an adult patient who have failed to normalize serum or has shown an inadequate response to conventional therapy
Please include the following information when submitting a referral for Lemtrada:
  • Most recent lab results
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Results of HIV testing
  • Patient has relapsing-remitting multiple sclerosis (RRMS) who has had an inadequate response to two or more drugs indicated for the treatment of MS
  • Baseline labs as required by REMS program
  • Results of Hep C testing
Please include the following information when submitting a referral for Lumizyme:
  • Patient is 8 years and older with late (non-infantile) onset Pompe disease (GAA deficiency) who has no evidence of cardiac hypertrophy
Please include the following information when submitting a referral for Injectafer:
  • Most recent lab results
  • Patient has iron deficiency anemia
Please include the following information when submitting a referral for Nucala:
  • List of current medications treating disease
  • Labs showing elevated eosinophil count of 150 cells/uL or higher
  • Clinicals showing number of asthma exacerbations in the last 12 months
  • FEV1 test results
  • Clinicals to support one or more of the following:
    • Add-on maintenance treatment of patients with severe asthma aged 6 years and older, and with an eosinophilic phenotype
    • Add-on maintenance treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) in adult patients 18 years of age and older with inadequate response to nasal corticosteroids
    • The treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA)
    • The treatment of adult and pediatric patients aged 12 years and older with hypereosinophilic syndrome (HES) for ≥6 months without an identifiable non-hematologic secondary cause
Please include the following information when submitting a referral for Nulojix:
  • List of current medications treating disease
  • Patient has history of prophylaxis of organ rejection and is receiving a kidney transplant
Please include the following information when submitting a referral for Ocrevus:
  • Hepatitis B virus lab results
  • Quantitative serum immunoglobulin results
  • Radiology confirming diagnosis
  • Patient has Relapsing multiple sclerosis
  • Patient has Primary progressive multiple sclerosis
Please include the following information when submitting a referral for Onpattro:
  • Supporting documentation of the diagnosis - Hereditary transthyretin-mediated (hATTR) amyloidosis.
Please include the following information when submitting a referral for Orencia:
  • Patient's current weight and height
  • Clinicals to support one or more of the following:
    • Patient has rheumatoid arthritis (RA)
    • Patient has juvenile idiopathic arthritis (JIA)
    • Patient has psoriatic arthritis
Please include the following information when submitting a referral for Prolastin-C:
  • Patient has shown clinical evidence of emphysema due to severe hereditary deficiency of Alpha-1 antitrypsin deficiency
Please include the following information when submitting a referral for Infliximab (Remicade, Inflectra, Renflexis, Avsola):
  • Result of Tuberculosis (TB) skin/ lab testing
  • Hepatitis B status & date
  • Patients current weight and height
  • Clinicals to support one or more of the following:
    • Patient has active moderate to severe Crohn’s disease (CD)
    • Patient has active moderately to severely active Ulcerative Colitis (UC)
    • Patient has Rheumatoid Arthritis (RA)
    • Patient has Psoriatic Arthritis
    • Patient has Ankylosing Spondylitis
    • Patient has Plaque Psoriasis
Please include the following information when submitting a referral for Rapid Infliximab (Remicade, Inflectra, Renflexis):
  • Result of Tuberculosis (TB) skin/ lab testing
  • Hepatitis B status & date
  • Patients current weight and height
  • Clinicals to support one or more of the following:
    • Patient has active moderate to severe Crohn’s disease (CD)
    • Patient has active moderately to severely active Ulcerative Colitis (UC)
    • Patient has Rheumatoid Arthritis (RA)
    • Patient has Psoriatic Arthritis
    • Patient has Ankylosing Spondylitis
    • Patient has Plaque Psoriasis
Please include the following information when submitting a referral for Rituximab (Rituxan, Truxima, Ruxience):
  • Patient's current weight and height
  • Hepatitis B status & date
  • Most recent CBC results
  • Patient has moderately to severely active rheumatoid arthritis (RA) and is currently taking methotrexate
Please include the following information when submitting a referral for Saphnelo:
  • Clinical information that supports the diagnosis of an adult patient with moderate to severe systemic lupus erythematosus (SLE)
Please include the following information when submitting a referral for Simponi Aria:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Patient's current weight and height
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active rheumatoid arthritis (RA) and is taking methotrexate
    • Patient has active psoriatic arthritis
    • Patient has active ankylosing spondylitis
Please include the following information when submitting a referral for Soliris:
  • Patient has been immunized with meningococcal vaccines at least 2 weeks prior to administering the first dose of Soliris
  • Clinicals to support one or more of the following:
    • Patient has Paraxysmal Nocturnal Hemoglobinuria (PNH)
    • Patient has atypical Hemolytic Uremic Syndrome (aHUS)
    • Patient has anti-AChR+ generalized Myasthenia Gravis (gMG)
    • Patient has anti-AQP4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder (NMOSD)
Please include the following information when submitting a referral for Solu-Medrol:
Please include the following information when submitting a referral for Stelara IV:
  • Result of Tuberculosis (TB) skin/lab testing
  • Patients current weight and height
  • Patient has active moderate to severe Crohn’s disease (CD)
    • Who has failed or was intolerant to treatment with immunomodulators or corticosteroids but never failed treatment with a tumor necrosis factor blocker
    • Or failed or were intolerant to treatment with one or more TNF blockers
  • Patient has active psoriatic arthritis
  • Patient has moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy
Please include the following information when submitting a referral for Stelara SQ:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Patient's current weight and height
  • For Crohn's patients, include date of induction dose given
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active Crohn’s disease (CD) and evidence to support one or more of the following:
      • Failed or was intolerant to treatment with immunomodulators or corticosteroids but never failed treatment with a tumor necrosis factor blocker OR
      • Failed or was intolerant to treatment with one or more TNF blockers
  • Patient has active psoriatic arthritis
  • Patient has moderate to severe plaque psoriasis who is a candidate for phototherapy or systemic therapy
Please include the following information when submitting a referral for Tepezza:
  • Clinicals to support one or more of the following:
    • Thyroid Eye Disease
    • Diagnosis code of E05.00
Please include the following information when submitting a referral for Thyrogen:
  • Patient has a history of thyroid cancer who has previously undergone thyroidectomy
Please include the following information when submitting a referral for Tysabri:
  • Clinicals to support one or more of the following:
    • Patient has relapsing-remitting multiple sclerosis (RRMS)
    • Patient has moderately to severely active Crohn’s disease (CD) who had an inadequate response to, or was unable to tolerate, conventional CD therapies and inhibitors of TNF
    • JCV results
Please include the following information when submitting a referral for Ultomiris:
  • Patient has been immunized with meningococcal vaccines at least 2 weeks prior to administering the first dose of Ultomiris
  • Clinicals to support one or more of the following:
    • Patient has Paraxysmal Nocturnal Hemoglobinuria (PNH)
    • Patient has atypical Hemolytic Uremic Syndrome (aHUS)
Please include the following information when submitting a referral for Venofer:
  • Most recent lab results
  • Patient has iron deficiency anemia, chronic kidney disease and is over 2 years of age
Please include the following information when submitting a referral for Vyepti:
  • Clinicals to support an indication for the preventive treatment of migraines in adult patients
  • Patient has a history of migraines and has been on 2 oral preventatives and has experienced 4 or more migraines within a month period
Please include the following information when submitting a referral for Xolair:
  • Patient’s current weight and height
  • IgE Lab results
  • FEV1 test results showing demonstrated airflow limitation: FEV1 less than 80%
  • Clinicals to support one or more of the following:
    • Patient has moderate to severe persistent asthma, is 6 years of age or older, has had a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids
    • Patient has chronic idiopathic urticaria, is 12 years of age or older and remains symptomatic despite H1 antihistamine treatment
    • Nasal polyps in adult patients 18 years of age and older with inadequate response to nasal corticosteroids, as add-on maintenance treatment
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