Tepezza Patient Enrollment Form

Tepezza Patient Enrollment Form - Web option 1 connect with a patient access liaison (pal) to help you explore enrollment options. Indicated for the treatment of thyroid eye disease (ted) regardless of disease activity or duration 1. Web select one of the following options. Download and review the prior authorization (pa) form and requirements from the payor. Option 2 sign up through your doctor’s office. Web 1 gather clinical information on patient’s thyroid eye disease (ted) diagnosis.

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Option 2 sign up through your doctor’s office. Web option 1 connect with a patient access liaison (pal) to help you explore enrollment options. Web select one of the following options. Indicated for the treatment of thyroid eye disease (ted) regardless of disease activity or duration 1. Web 1 gather clinical information on patient’s thyroid eye disease (ted) diagnosis. Download and review the prior authorization (pa) form and requirements from the payor.

Web Select One Of The Following Options.

Download and review the prior authorization (pa) form and requirements from the payor. Web 1 gather clinical information on patient’s thyroid eye disease (ted) diagnosis. Option 2 sign up through your doctor’s office. Web option 1 connect with a patient access liaison (pal) to help you explore enrollment options.

Indicated For The Treatment Of Thyroid Eye Disease (Ted) Regardless Of Disease Activity Or Duration 1.

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