Prescription and Service Request Form

Acquiring CINQAIR® Administering CINQAIR® Supporting Patients FAQs Resources

Acquiring CINQAIR® (reslizumab) Injection

CINQAIR® can be ordered from one of our Authorized Specialty Distributors (Buy & Bill) or, subject to a patient’s health plan requirements, CINQAIR® may also be acquired from a specialty pharmacy.


Buy & Bill

These Authorized Specialty Distributors are the exclusive suppliers of CINQAIR®.

Contact the individual specialty distributor for current pricing.

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Specialty Pharmacy

In situations where a treatment provider prefers to acquire CINQAIR® via a speciality pharmacy, or when a patient's health plan mandates a specialty pharmacy:

  1. Select specialty pharmacy as the preferred acquisition method on the Prescription and Service Request Form. Teva Support Solutions® will confirm specialty pharmacy requirements.
  2. Teva Support Solutions® will refer the prescription to the specific specialty pharmacy to fulfill and ship CINQAIR® to a site of administration if the patient’s health plan requirements are met.

Note: The specialty pharmacy may contact the prescriber to request additional information, including a request to re-send a CINQAIR® prescription directly to the specialty pharmacy.

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Once the patient receives their treatment, submit a reimbursement claim to the patient’s health insurance plan for the cost of medication and infusion administration.

If using a specialty pharmacy, submit a reimbursement claim for the infusion administration only.

Download the At-a-Glance Guide to Codes for CINQAIR® for support in completing a reimbursement claim.