Teva-Support

Prescription and Service Request Form

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How do I request services to get support for my patients?

To get services to support your patients, be sure to complete the "Services Requested" section at the top of the Prescription and Service Request Form. Services offered include benefit verification and patient financial assistance.

Teva Support Solutions® will provide you with a Summary of Benefits and contact your patients about their insurance coverage and any financial support available to them.

For more information, go to Supporting Patients or call Teva Support Solutions® at 1-844-838-2211, Monday through Friday, 9 am to 7 pm ET.