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Sustol resources that you can download for your practice
Reimbursement materials
SUSTOL Distribution Reference Guide
SUSTOL Distribution Reference Guide

Form explaining how and where to order SUSTOL.

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SUSTOL CMS 1450 claim form
Sample CMS-1450 (UB-04) Claim Form

Sample form with annotations and instructions.

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SUSTOL Insurance verification enrollment program form
Insurance Verification and Program Enrollment Form

One single form used to verify benefits and enroll patients in SUSTOL Connect™ Programs.

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SUSTOL CMS 1500 claim form
Sample CMS-1500 Claim Form

Sample form with annotations and instructions.

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SUSTOL reimbursement support brochure
Reimbursement Assistance Brochure

A brochure that details the benefits of SUSTOL Connect™, including the fully integrated reimbursement and patient support program it offers.

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A letter with a customizable template for you to use if a health plan denies a patient access to SUSTOL
Sample Letter of Appeal

A letter with a customizable template for you to use if a health plan denies your patient access to SUSTOL.

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A form your practice must complete in order to be eligible for the Stand by SUSTOL Program
Stand by SUSTOL Enrollment Form

A form your practice must complete in order to be eligible for the Stand by SUSTOL Program.

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Customizable letter your practice can use to provide insurance companies with a brief medical rationale for the use of SUSTOL
Sample Letter of Medical Necessity

A customizable letter your practice can use to provide health plans with a brief medical rationale for the use of SUSTOL.

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A form to help you submit the appropriate information to insurance companies regarding treating appropriate patients with SUSTOL, including patient information and medical assessment
Statement of Medical Necessity

A form to help you submit the appropriate information to health plans regarding treating appropriate patients with SUSTOL, including patient information and medical assessment.

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A form used to enroll individual patients solely into the SUSTOL Copay Assistance Program. The one-time Copay Assistance Program Practice Enrollment Form must also be completed
Patient Copay Assistance Program Registration Form

A form used to enroll individual patients solely into the SUSTOL Copay Assistance Program. The one-time Copay Assistance Program Practice Enrollment Form must also be completed.

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A one-time form your practice must complete in order to participate in the simplified Copay Assistance Registration process
SUSTOL Copay Assistance Program Practice Enrollment Form

A one-time form your practice must complete in order to participate in the simplified Copay Assistance Registration process.

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Clinical materials
SUSTOL Instructions for Use
Instructions for Use (IFU)

A document with information about the preparation and administration of SUSTOL.

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SUSTOL Administration Tear Sheet
Administration Tear Sheet

Illustrated overview and helpful hints to administer SUSTOL.

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Patient resource
SUSTOL provides you with protection that lasts
Patient Education Brochure

A brochure that you can use to educate your patients about CINV and why SUSTOL was prescribed for them.

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Indication

SUSTOL is indicated in combination with other antiemetics in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide (AC) combination chemotherapy regimens.

Important Safety Information

Contraindications

SUSTOL is contraindicated in patients with hypersensitivity to granisetron, any of the components of SUSTOL, or any other 5-HT3 receptor antagonist.

Warnings and Precautions

Injection site reactions (ISRs), including infection, bleeding, pain and tenderness, nodules, swelling, and induration, have occurred with SUSTOL. Monitor for ISRs following SUSTOL injection. Inform patients that some ISRs may occur 2 weeks or more after SUSTOL administration. In patients receiving antiplatelet agents or anticoagulants, consider the increased risk of bruising or severe hematoma prior to the use of SUSTOL.

Monitor for constipation and decreased bowel activity and consider optimizing patients’ current bowel regimens used for managing preexisting constipation. Instruct patients to seek immediate medical care if signs and symptoms of ileus occur.

Hypersensitivity reactions have been reported and may occur up to 7 days or longer following SUSTOL administration and may have an extended course. If a reaction occurs, administer appropriate treatment and monitor until signs and symptoms resolve.

Serotonin syndrome has been reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs.

Use in Specific Populations

Avoid SUSTOL in patients with severe renal impairment. In patients with moderate renal impairment, administer SUSTOL not more frequently than once every 14 days.

Adverse Reactions

Most common adverse reactions (≥3%) are injection site reactions, constipation, fatigue, headache, diarrhea, abdominal pain, insomnia, dyspepsia, dizziness, asthenia, and gastroesophageal reflux.

For more information about SUSTOL, please see full Prescribing Information.





Indication

SUSTOL is indicated in combination with other antiemetics in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide (AC) combination chemotherapy regimens.

Important Safety Information

Contraindications

SUSTOL is contraindicated in patients with hypersensitivity to granisetron, any of the components of SUSTOL, or any other 5-HT3 receptor antagonist.

Warnings and Precautions

Injection site reactions (ISRs), including infection, bleeding, pain and tenderness, nodules, swelling, and induration, have occurred with SUSTOL. Monitor for ISRs following SUSTOL injection. Inform patients that some ISRs may occur 2 weeks or more after SUSTOL administration. In patients receiving antiplatelet agents or anticoagulants, consider the increased risk of bruising or severe hematoma prior to the use of SUSTOL.

Monitor for constipation and decreased bowel activity and consider optimizing patients’ current bowel regimens used for managing preexisting constipation. Instruct patients to seek immediate medical care if signs and symptoms of ileus occur.

Hypersensitivity reactions have been reported and may occur up to 7 days or longer following SUSTOL administration and may have an extended course. If a reaction occurs, administer appropriate treatment and monitor until signs and symptoms resolve.

Serotonin syndrome has been reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs.

Use in Specific Populations

Avoid SUSTOL in patients with severe renal impairment. In patients with moderate renal impairment, administer SUSTOL not more frequently than once every 14 days.

Adverse Reactions

Most common adverse reactions (≥3%) are injection site reactions, constipation, fatigue, headache, diarrhea, abdominal pain, insomnia, dyspepsia, dizziness, asthenia, and gastroesophageal reflux.

For more information about SUSTOL, please see full Prescribing Information.