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Find the right resources to assist your BAXFENDY patients

BAXFENDY Patient Authorization Form

BAXFENDY Intake Form

A multi-page intake form to capture necessary patient, provider, and clinical information to start a request for support.

Understanding Your Commercial Insurance Flashcard

BAXFENDY Patient Authorization Form

Ensure your patients complete and sign the BAXFENDY Patient Authorization Form so Access 360 can provide select services.

Understanding Medicare Brochure

Sample Letter of Medical Necessity

This template can be used by a healthcare provider to respond to a patient’s insurance company requesting a letter of medical necessity for prescribing an AstraZeneca medicine.

Understanding Your Medicare Part D Benefit and Prescription Payment Option

BAXFENDY Sample Letter of Appeal

This template can be used by a healthcare provider to appeal a denial of access to an AstraZeneca medicine.