Resources for patients and healthcare professionals
Resources
Teva Support Solutions® offers a range of practice support materials and resources for healthcare providers.
CINQAIR® Prescription & Services Request Form
Enroll patients in Teva Support Solutions® with this one-page prescription form for CINQAIR® (rezlizumab) Injection
Guide to Prescription & Services Request Form
Offers step-by-step instructions for completing the Prescription & Service Request Form
At-a-Glance Guide to Codes for CINQAIR®
Provides billing and coding support for completing a reimbursement claim for CINQAIR®
CINQAIR® Cost Support Program Brochure for PROVIDERS
Gives an overview on how to enroll patients, and how patients use the Program to help pay for treatment
CINQAIR® Cost Support Program Brochure for PATIENTS
Explains the Program to patients, including how to get started and how the Program works to help pay for treatment
Sample Letter of Medical Necessity
Provides a template for requesting coverage approval by a patient’s health insurance plan
Sample Letter of Appeal
Provides a template for appealing a coverage denial decision by a patient’s health insurance plan