GVF wishes to acknowledge that Incyte Corp, maker of ruxolitinib (Opzelura), is a financial supporter of the Global Vitiligo Foundation. We are posting this letter of medical necessity (LOMN) because this is the first, and currently the only, FDA-approved drug for vitiligo repigmentation, and not because they are a financial sponsor. As other drugs are approved by the FDA, we will review the data and, if warranted, create a LOMN for that drug as well.
In-office Phototherapy Letter
In-office Excimer Letter
Home Phototherapy Letter
Pre-Authorization Request Template
Want to see the letter before downloading it? See a copy of the letter here.
Letter of Medical Necessity
Want to see the letter before downloading it? See a copy of the letter here.
Phototherapy dosing instructions and tracking
Notice:
The information provided in the document above should only be used under the guidance of your physician/doctor/medical professional. Use your phototherapy device as you would a prescription medication under the direction of a physician. Like any medication, phototherapy can be harmful if not used properly.
