Embedded Files
Below you will find the direct links to the reimbursement request forms and the medical report template.
Nederlands
Nederlands
Officiële formulieren voor terugbetalingsaanvragen :
Medisch verslag template voor aanvullende terugbetalingsaanvraag :
Français
Français
Formulaires officiels de demande de remboursement :
Template de rapport medical à joindre aux demandes additionnelles :
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▼ Klisyri® is indicated for the field treatment of non-hyperkeratotic, non-hypertrophic actinic keratosis (Olsen grade 1) of the face or scalp in adults. Klisyri® is associated with the recurrence of lesions at 1 year. Trials comparing tirbanibulin with conventional treatments and that have longer follow-up are needed to determine the effects of tirbanibulin therapy on actinic keratosis.
Almirall nv/sa
Lenneke Marelaan 4
1932 Sint-Stevens-Woluwe
BE-KLI-2600012 March 2026
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