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.

How to Complete an 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.

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.

IRESSA Affordability Brochure

IRESSA Affordability Brochure

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