For you and your office staff
ANZUPGO ACCESS AND SAVINGS PROGRAMS OVERVIEW BROCHURE
Learn about the access and savings programs available to your eligible patients prescribed ANZUPGO.
PRODUCT FACT SHEET AND PRESCRIPTION GUIDE
Learn about ANZUPGO and how to prescribe through one of the ANZUPGO enhanced services pharmacies.
SAMPLE LETTER OF MEDICAL EXCEPTION AND MEDICAL NECESSITY
You may use this sample letter and modify as needed when submitting a letter of medical exception and medical necessity for ANZUPGO to submit to your patient’s health insurance plan.
MEDICAL EXCEPTION AND MEDICAL NECESSITY CHECKLIST
Refer to this checklist when preparing a letter of medical exception and medical necessity to submit to your patient’s health insurance plan.
PRIOR AUTHORIZATION CHECKLIST
Refer to this checklist when preparing a prior authorization submission to your patient’s health insurance plan.
SAMPLE LETTER OF APPEAL
You may use this sample letter and modify as needed when your patient’s health insurance plan has denied or limited coverage of ANZUPGO.
SAMPLE LETTER OF APPEAL (APPROVAL FOR ADDITIONAL TUBE)
You may use this sample letter and modify as needed when your patient’s health insurance plan has denied coverage of an additional ANZUPGO tube.
APPEAL CHECKLIST
Refer to this checklist if a request for coverage of ANZUPGO is
denied and an appeal is appropriate.
For your patients
ANZUPGO PATIENT BROCHURE
Share this brochure with your patients so they can learn about their treatment with ANZUPGO and the access and savings programs available.
ANZUPGO COPAY PROGRAM BROCHURE
Share this brochure with your eligible commercially insured patients to help them understand how the ANZUPGO Copay Program may help reduce their copay costs for ANZUPGO.
COPAY REIMBURSEMENT FORM
Your patients can complete and submit this form to request reimbursement for eligible copay payments made for ANZUPGO prescriptions.