Access 360 General Patient Authorization Form (PAF)

Find the right resources to assist your KOSELUGO patients

TRADENAME Enrollment Form

KOSELUGO 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.

TRADENAME Coding Resource

KOSELUGO Coding Resource

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

TRADENAME Distribution Sheet

KOSELUGO Distribution Sheet

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

TRADENAME Affordability Brochure

KOSELUGO Affordability Brochure

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