Tepezza Patient Enrollment Form

Tepezza Patient Enrollment Form - Patient Enrollment Form To get your patient started on TEPEZZA complete the Patient Enrollment Form DOWNLOAD It s just amazing how well this medication has taken care of my eyes I can t imagine people having what I had with nothing to help them I can t imagine having to live with my eyes like that

Patient Enrollment Form Once complete submit by Fax 1 833 469 8333 or email TEPEZZAHBYS horizontherapeutics Complete all required felds including prescriber s signature and date to initiate patient enrollment process

Tepezza Patient Enrollment Form

Tepezza Patient Enrollment Form

Telephone/Fax Medication: TEPEZZA (teprotumumab-trbw) for injection, for intravenous use // 500mg vial Duration: 1 infusion every 3 weeks for a total of 8 infusions. Administer the first two infusions over 90 minutes. Subsequent infusions may be reduced to 60 minutes if well tolerated.

Complete a Patient Enrollment Form Find a TED Specialist Request a Representative Sign Up for Updates TREATMENT INITIATION PAYOR ACCESS BILLING AND CODING INFUSION PATIENT EDUCATION Helpful resources and downloadable assets to support your practice and your patients Patient Enrollment Form

Span Class Result Type

Option 1 Connect with a Patient Access Liaison PAL to help you explore enrollment options Call 1 833 469 8331 Option 2 Sign up through your doctor s office They can start the enrollment on HorizonByYourSide and submit it on your behalf Patient consent is required

Patient Assistance Program Novartis

Patient Enrollment Form Once complete submit by Fax 1 833 469 8333 or email TEPEZZAHBYS horizontherapeutics First name Name Office contact telephone NPI Medication TEPEZZA teprotumumab trbw for injection for intravenous use 500 mg vial Duration 1 infusion every 3 weeks for a total of 8 infusions Administer the first 2

Preparation And Administration TEPEZZA Teprotumumab Trbw For HCPs

Patient Enrollment Form If you have been prescribed TEPEZZA and would like to opt in for support from Horizon By Your Side to get help from a Patient Access Liaison download this form and give it to your doctor Be sure to sign the space that gives your consent to receive services and financial support If you have questions please call

Janssen Carepath Tremfya Enrollment Form Enrollment Form

Patient Enrollment Form Once complete submit by Fax 1 833 469 8333 or email TEPEZZAHBYS horizontherapeutics Complete all required fields including prescriber s signature and date to initiate patient enrollment process

Complete a Patient Enrollment Form Find a TED Specialist Request a Representative Sign Up for Updates TEPEZZA is a prescription medication administered via IV infusion

Span Class Result Type

Once you decide TEPEZZA is right for your patient it s easy to start their enrollment in Horizon By Your Side with the Patient Enrollment Form PEF and submit it using one of two convenient options Patient consent will be required Online Submission Simply fill out the form sign and submit online through DocuSign Begin DocuSign

Tepezza Patient Enrollment Form

Patient Enrollment Form Once complete submit by Fax 1 833 469 8333 or email TEPEZZAHBYS horizontherapeutics Complete all required fields including prescriber s signature and date to initiate patient enrollment process

Patient Enrollment Form Once complete submit by Fax 1 833 469 8333 or email TEPEZZAHBYS horizontherapeutics Complete all required felds including prescriber s signature and date to initiate patient enrollment process

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