Repatha Patient Assistance Form

Repatha Patient Assistance Form - For adults with heart disease Get Helpful Resources With Amgen SupportPlus Whether you re taking Repatha or considering asking your doctor about a prescription Amgen provides helpful resources to support you on your path to lowering high bad cholesterol LDL C

Adverse Reactions in the Cardiovascular Outcomes Trial The most common adverse reactions 5 of patients treated with Repatha and more frequently than placebo were diabetes mellitus 8 8 Repatha 8 2 placebo nasopharyngitis 7 8 Repatha 7 4 placebo and upper respiratory tract infection 5 1 Repatha 4 8 placebo

Repatha Patient Assistance Form

Repatha Patient Assistance Form

Call 1-844-REPATHA Monday - Friday 9:00 am - 8:00 pm ET Taking Repatha®? With personalized solutions you may need, Amgen® SupportPlus is here to help. Learn more today!

STEP 1 Complete all sections of the PATIENT APPLICATION pages 1 3 Applications missing required information cannot be processed STEP 2 Have your physician fill out the PRESCRIPTION page 4 STEP 3 Have your prescribing physician fax the completed application and prescription to 1 833 959 1409 Please keep this page for your records

HCP Resources Repatha Evolocumab Amgen Inc

PATIENT APPLICATION pages 1 3 Applications missing required information cannot be processed STEP 2 Have your physician fill out the PRESCRIPTION page 4 STEP 3 Have your prescribing physician fax the completed application and prescription to 1 866 549 7239 What happens after I apply

Bristol Myers Patient Assistance 2019 2023 Form Fill Out And Sign Printable PDF Template SignNow

An original prescription is also accepted in place of the prescription section on this form Dose One 140 mg ml Sureclick One 420 mg ml Pushtronex Refills 1 year or x Patient Diagnosis Code ICD 10 required if patient has insurance ICD 10 Frequency Once every two weeks Once monthly Dispense Amount 90 days Repatha evolocumab injection

Amgen SupportPlus Enrollment Repatha Evolocumab

1 844 737 2842 Monday Friday 9 00 am 11 00 pm ET For additional information about Repatha visit Repathahcp Discover patient support and resources for Repatha through Amgen SupportPlus today

Fillable Form Gl2443 Group Benefits Prior Authorization Repatha Evolocumab 2016

Support Resources Repatha Co Pay Card Get Helpful Resources Whether you re taking Repatha or considering asking your doctor about a prescription Amgen provides helpful resources to support you on your path to lowering high bad cholesterol LDL C For Repatha patients Amgen

ENROLMENT FORM Fax completed form to 1-844-737-2841 Questions? Call 1-888-Repatha (1-888-737-2842) or email [email protected] Patient information Name (first, last) Phone (preferred) Date of birth (DD/MM/YYYY) Best time to call Morning Phone (alternate) Afternoon Evening Sex Do not leave a voicemail Email Address City, Province

Repatha Patient Support Program Resources Amgen

EMAIL We re Right Here Right When You Need Us Personalized support that you and your patients can count on across Amgen therapies Financial Support We know every patient has unique needs And we re here to provide financial support information and resources regardless of their current financial situation or type of insurance they have

Repatha Patient Assistance Form

Support Resources Repatha Co Pay Card Get Helpful Resources Whether you re taking Repatha or considering asking your doctor about a prescription Amgen provides helpful resources to support you on your path to lowering high bad cholesterol LDL C For Repatha patients Amgen

Adverse Reactions in the Cardiovascular Outcomes Trial The most common adverse reactions 5 of patients treated with Repatha and more frequently than placebo were diabetes mellitus 8 8 Repatha 8 2 placebo nasopharyngitis 7 8 Repatha 7 4 placebo and upper respiratory tract infection 5 1 Repatha 4 8 placebo

Repatha Sureclick Patient Assistance Program