Download Axumin® (fluciclovine F 18) Resources
Download all formulary components or choose one or more of the individual components below.
- Disease Overview: Brief summary of biochemically recurrent prostate cancer, current imaging paradigms, and the unmet clinical need in PET/CT imaging.
- Clinical Summary: A detailed summary of the Axumin clinical studies, including the rationale, study background, and clinical endpoints. Also includes a description of the product’s mechanism of action (MOA).
- Clinical Bibliography: A list of publications describing the safety and efficacy of Axumin.
- Indication and ISI: Full Axumin Indication and Important Safety Information (ISI).
- Dosing and Administration Guide: Detailed instructions for dosing and administration, including positioning patients, recommended timing for PET/CT imaging, and approximate timing for image acquisition.
- Safety Data Sheet: Health and safety precautions for the preparation, handling, and use of Axumin.
- Coding Sheet: Relevant product, procedure, and diagnosis coding information applicable for billing purposes.
- Ordering Information: Information to order Axumin for your facility and the list of services our sales representatives can provide.
Download all imager resources or choose one or more of the individual components below.
- Press Release Template: Customizable press release template to announce Axumin® (fluciclovine F 18) injection availability at your imaging center.
- Direct Mail Template: Customizable template to raise awareness of Axumin® (fluciclovine F 18) injection availability to referring physicians.
- Patient Brochure: Downloadable patient brochure with space on the back for your imaging center's location information.
Reimbursement tip sheet
Download a checklist with useful tips for prior-authorization, pre-determination, and appeals.
Blue Earth has developed a worksheet to help you keep track of the Axumin coverage policies and billing requirements of your local payers
Patient benefit investigation form
To enroll a patient for Axumin reimbursement support services, healthcare professionals must download, complete, and submit the Axumin Patient Benefit Investigation Form.
For use by referring physicians when scheduling a patient for Axumin imaging. Provides the relevant information that may be required by the imaging facility. Download the Scheduling Sheet and/or the companion Scheduling Tip Sheet.
Sample claim forms
Download examples of Axumin claim information entered into CMS-1500 and UB-04 forms to use as a reference when submitting claims.
Download the Axumin patient brochure in English or Spanish.