Formulary Request Letter

Please note: When billing ALOXI using J2469, the billing unit is 25 mcg.ALOXI should be billed at 10 units for a 0.25 mg dose.

To download a template of the Formulary Request Letter that you can customize and submit, simply click the "Formulary Request Letter" button below.

During initial and repeat courses of chemotherapy, ALOXI helps prevent and control nausea and vomiting the day following chemotherapy that is highly likely to cause nausea and vomiting, and for up to 5 days following chemotherapy that is likely to cause nausea and vomiting. The most frequent side effects of ALOXI include headache and constipation. If you have or may develop significant heart rhythm changes, talk with your healthcare professional before receiving ALOXI.

ALOXI is available by prescription only. Please see the important product information for ALOXI for more information.

This site does not contain everything that is known about ALOXI. If you would like to know more, talk to your healthcare professional.