Otezla Enrollment Form

Apremilast (Otezla) For Hidradenitis Suppurativa Somalaser

Otezla Enrollment Form. Web request form request assistance with benefits verification, prior authorization requirements, and specialty pharmacy triage. Web otezla® specialty pharmacy (sp) start form step 1:

Apremilast (Otezla) For Hidradenitis Suppurativa Somalaser
Apremilast (Otezla) For Hidradenitis Suppurativa Somalaser

Web otezla® specialty pharmacy (sp) start form step 1: Select maintenance dose 3 o p.o. * eligibility criteria and program. Please completeall fields on this form (to prevent delays in processing). Web request form request assistance with benefits verification, prior authorization requirements, and specialty pharmacy triage. Please complete this form if you’d like an sp to provide prior.

Select maintenance dose 3 o p.o. Web request form request assistance with benefits verification, prior authorization requirements, and specialty pharmacy triage. Select maintenance dose 3 o p.o. * eligibility criteria and program. Please completeall fields on this form (to prevent delays in processing). Web otezla® specialty pharmacy (sp) start form step 1: Please complete this form if you’d like an sp to provide prior.