Video Tutorial

To see a very short video tutorial on this follow this link.


Create Request Process


1. Select Prior Authorization

To find the prior authorization request:

  • Select Pharmacy network, the prior authorization.
  • If you request financial assistance regularly it will appear on the homepage.


2. Complete the Form

The minimum information we need is:

  • Patient name
  • Method to contact the patient (e.g. phone number or email)
  • Prescriber

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