Resources to help support you and your patients

ForgingBridges
Start Form

Use this form to prescribe Attruby for your appropriate patients and enroll them in the ForgingBridges Support Program

Download

Descargar en español

ForgingBridges Patient
Consent Form

Your patient may sign this standalone Patient Consent Form OR the patient section within the Attruby Start Form to enroll in ForgingBridges

Download

Descargar en español

Prior Authorization Support Through
CoverMyMeds

CoverMyMeds can help simplify prior authorization submissions with an electronic prior authorization (ePA) platform that enables submission to all health plans.

Call 1‑866‑452‑5017 or visit covermymeds.health to get started.

Prior Authorization and Appeals Checklists

This quick reference guide provides helpful tips for requesting prior authorization or submitting an appeal if your patient’s insurance plan denies coverage for Attruby.

Download

Annotated Sample Coverage
Determination Form

The information in this resource provides tips for submitting a coverage determination request related to Attruby on behalf of your patient with Medicare Part D prescription drug coverage.

Download

Sample Letter of Medical Necessity

This resource provides an example of the types of information to consider when submitting a letter of medical necessity to your patient’s insurance plan.

Download

Sample Letter of Appeal

This resource provides an example of the types of information to consider when submitting an appeal letter to your patient’s insurance plan when reimbursement for a claim is underpaid or denied or when a prior authorization is denied.

Download

Medicare Part D Guide
for Patients

Educates patients with Medicare Part D on the Medicare Prescription Payment Plan and eligibility for low-income subsidy.

Download

Commercial Copay
Assistance Program
Brochure

Provides your patients with information about the ForgingBridges Copay Assistance Program.

Download

Independent Foundations

Connect your patients to financial assistance through independent 501(c)(3) foundations based on their unique needs through the RE Assist dashboard.

Get more information