Arikayce Enrollment Form

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Arikayce Enrollment Form. Web arikares support program enrollment form and prescription (rx) to get started, submit all pages of this form through fax: The arikares enrollment form allows you to both prescribe arikayce and enroll your patients in the arikares support program.

Web to prescribe arikayce, first complete the arikares ® enrollment form with your patients. Web arikayce® prescription andarikares® support program enrollment form fax: The arikares enrollment form is the way for you to prescribe arikayce and to automatically enroll your patients in the arikares support program. A patient's signature on the enrollment form gives them access to support services. Arikayce is a prescription medicine used to treat adults with refractory (difficult to treat) mycobacterium avium complex (mac) lung disease as part of a combination antibacterial drug treatment plan (regimen). Web step 1 your doctor will add arikayce to your multidrug treatment these medications work together to fight the bacteria. Web arikares support program enrollment form and prescription (rx) to get started, submit all pages of this form through fax: Step 2 you’ll be welcomed into the arikares support program Enrollment@arikares.com please complete all fields on pages 1 and 3 to prevent any delays and include scanned copies of both sides of the patient’s insurance card (fields marked with an asterisk [*] are mandatory/required). To prescribe arikayce, this form must be completed.

It is not known if arikayce is safe and effective in children younger than 18 years of age. The arikares enrollment form allows you to both prescribe arikayce and enroll your patients in the arikares support program. Web do you need the arikares enrollment form? Web to prescribe arikayce, first complete the arikares ® enrollment form with your patients. Web arikayce® prescription andarikares® support program enrollment form fax: Web to prescribe arikayce, complete the arikares enrollment form with your patients. Download and print the arikares enrollment form and complete it with your doctor at your next appointment. Web arikares support program enrollment form and prescription (rx) to get started, submit all pages of this form through fax: Enrollment@arikares.com please complete all fields on pages 1 and 3 to prevent any delays questions? Arikayce is a prescription medicine used to treat adults with refractory (difficult to treat) mycobacterium avium complex (mac) lung disease as part of a combination antibacterial drug treatment plan (regimen). Patient signature is required for enrollment in arikares.