Access 360 General Patient Authorization Form (PAF)

Find the right resources to assist your IRESSA patients

IRESSA Enrollment Form

IRESSA Enrollment Form

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

IRESSA Coding Resource

IRESSA Coding Resource

This resource provides specific codes related to diagnosing and billing for IRESSA.

IRESSA_Distribution_Information

IRESSA Distribution Sheet

This piece provides a contact list of specialty pharmacy providers and specialty distributors that handle IRESSA.