For reimbursement support, contact R-Pharm US Access and Support in one of the following ways:
R-Pharm US Access and Support enrollment formFill out this form with the help of your doctor or nurse to enroll in the R-Pharm US Access and Support program. This program offers helpful access and support resources. It can help review what benefits are covered under your plan for R-Pharm US medicines. It can also assist with the cost of your medicine if you have no active insurance.
R-Pharm US Access and Support patient authorization formFill out this form to allow the R-Pharm US Access and Support program to provide you with services and assistance. This form should be used only if you filled out an R-Pharm US Access and Support enrollment form but did not sign it.
The information provided is intended for use by individuals involved with reimbursement support.
The accurate completion of reimbursement or coverage-related documentation is the responsibility of the healthcare provider and patient. R-Pharm US and its agents make no guarantee regarding reimbursement for any service or item.