Otezla Bridge Program Form

Otezla Bridge Program Form - STEP 1 Provide an Otezla sample Starter Pack so patients can start taking Otezla right away Provide the 14 day sample Starter Pack to patients before they leave the office or prescribe the 28 day Starter Pack STEP 2 Initiate the prior authorization PA process You can initiate prior authorizations PAs by paper or electronically

Request Form Request assistance with benefits verification prior authorization requirements and specialty pharmacy triage Download Amgen SupportPlus Patient Request Form Request Amgen SupportPlus to contact your patients directly to start their Amgen SupportPlus enrollment Download Call 1 844 4OTEZLA Monday Friday 8 00 am 8 00 pm ET

Otezla Bridge Program Form

Otezla Bridge Program Form

WHAT IS PLAQUE PSORIASIS? Amgen ® SupportPlus Together, we've got this. When you're prescribed Otezla, you're never alone. We're right here, right when you need us Personalized patient support designed for you. With financial support resources and other helpful patient services, we are here to help you along the way. Help with insurance questions

Step 1 Please completeall fields on this form to prevent delays in processing Step 2 Fax this form and copies of both sides of insurance and pharmacy benefit cards to the specialty pharmacy SP of your choice or to Otezla SupportPlusTM

Otezla HCP Patient Support Program Resources Amgen

Call 1 844 4OTEZLA Monday Friday 8 00 am 8 00 pm ET Personalized patient support designed for you with Otezla patient support resources through Amgen SupportPlus Learn more now

Otezla Patient Assistance Program

WHAT IS PLAQUE PSORIASIS Whether you are considering Otezla or have been recently prescribed you can sign up today for more information Considering Otezla Get Otezla information and resources for your upcoming appointment s Starting Otezla

How To Start Patients On Otezla Apremilast

START Form for Specialty Pharmacy Step 1 Please complete all fields on this form to prevent delays in processing Step 2 Fax this form along with the signed HIPAA Authorization and copies of both sides of insurance and pharmacy benefit cards to the specialty pharmacy SP of your choice

Otezla Birth Defects And Suicide RxISK

Otezla Specialty Pharmacy SP START Form Step 1 Please complete this form if you d like an SP to provide prior authorization support or to process a prescription Step 2 Fax this form along with copies of the front and back of both your patient s insurance and prescription

ENROLL NOW † Eligibility criteria and program maximums apply. See AmgenSupportPlus.com/copay-terms for full Terms and Conditions. Any questions? Call 1-844-4OTEZLA (1-844-468-3952) and speak to an Amgen ® SupportPlus Representative (available 8 AM - 8 PM ET, Monday - Friday). Helping you access your prescribed treatment

Amgen SupportPlus Otezla Apremilast For PsO

Step 1 Step 2 front and back BV assistance By completing I would like Otezla SupportPlusTM to initiate a BV PA requirements By completing I am requesting Otezla SupportPlusTM to verify if a PA is required or not If a PA form is needed Otezla SupportPlusTM can provide the matching insurance form

Otezla Bridge Program Form

Otezla Specialty Pharmacy SP START Form Step 1 Please complete this form if you d like an SP to provide prior authorization support or to process a prescription Step 2 Fax this form along with copies of the front and back of both your patient s insurance and prescription

Request Form Request assistance with benefits verification prior authorization requirements and specialty pharmacy triage Download Amgen SupportPlus Patient Request Form Request Amgen SupportPlus to contact your patients directly to start their Amgen SupportPlus enrollment Download Call 1 844 4OTEZLA Monday Friday 8 00 am 8 00 pm ET

ACTIVE Safety Data In Otezla For The Treatment Of Psoriatic Arthritis In Adult Patients Otezla