Access 360 General Patient Authorization Form (PAF)

Find the right resources to assist your IMFINZI patients

IMFINZI Enrollment Form

IMFINZI Enrollment Form

A multi-page enrollment form to capture necessary patient, provider, and prescription information to start a new request for support.

Access 360 Enrollment Form

How to Complete an Access 360 Enrollment Form

This annotated guide provides direction on how to complete each section of the Access 360 Enrollment Form.

IMFINZI Coding Resource

IMFINZI Coding Resource

This resource provides specific codes related to diagnosing and billing for IMFINZI. IMFINZI J-Code: J9173

IMFINZI J-Code Flashcard

IMFINZI J-Code Flashcard

Use this resource to ensure the correct code is used to identify IMFINZI.

IMFINZI Distribution Sheet

IMFINZI Distribution Sheet

This sheet provides the contact information of authorized Specialty Pharmacy Providers and Specialty Distributors, from which IMFINZI can be obtained.

IMFINZI Affordability Brochure

IMFINZI Affordability Brochure

This piece provides information for those patients seeking affordability for their IMFINZI medication.