Rebif® (interferon beta-1a) PRESCRIPTIONS AND SERVICE REQUEST FORM Send Fax 1-866-227-3243 Questions? Call Us 1-877-447-3243

The Service Request Form (SRF) provides you with an easy and convenient way to prescribe Rebif ®. Just download and print it, fill it out, and fax it to 1-866-227-3243 to get started. …

Currently there are three interferon beta-1a agents (Rebif, Avonex, and Plegridy). The three products differ in dose and frequency of dosing (three times a week, once weekly, and once …

Attached is a Prior Authorization request form. Now you can get responses to drug Prior Authorization requests securely online. responses and do not require faxing or phone calls. …

if you are not the patient or the prescriber, you will need to submit a phi disclosure authorization form with this request which can be found at the following link: …

Medicare, Medicaid, and commercial pharmacy prior authorization forms. general forms | drug-specific forms by payer | forms by region & state.

How to order: The supply of a REBIF ® device and related consumables is available to patients as part of the REBIF ® adveva™ patient support programme. To order a RebiSmart ® or …

Fax this form to: 1-866-227-3243 | Call us toll free: 1-877-447-3243 Rebif® (interferon beta-1a) PRESCRIPTIONS AND SERVICE REQUEST FORM STEP 1: Complete Physician …

Updated Rx prior authorization form for Rebif by region & plan

Rebif ® (interferon beta-1a) is a prescription medicine used to treat relapsing forms of multiple sclerosis, to include clinically isolated syndrome, relapsing-remitting disease, and active …