
A multi-page enrollment form to capture necessary patient, provider, and clinical information to start a new request for support.
A single-page overview of the key steps for obtaining LOKELMA.
This guide provides an overview of the support offerings for LOKELMA, and outlines how we can help to ease the access process for your patients.
A resource describing ways in which patients can pay for LOKELMA if it is approved or denied.
Checklists designed to be used as a reference during the prior authorization (PA) and denial/appeal processes for LOKELMA.
A quick reference for understanding the offerings provided for LOKELMA.
This template is offered as a resource a healthcare provider could use when responding to a request from a patient’s insurance company to provide a letter of medical necessity for prescribing LOKELMA.
This template is a sample resource a healthcare provider could use when responding to a request from a patient's insurance company to provide a letter of medical necessity for prescribing LOKELMA.
This template is offered as a resource a healthcare provider could use when requesting a Tier Exception from a patient’s health benefits company when LOKELMA is non-preferred.
Use this template when requesting an Exception for a Formulary/Plan Exclusion for LOKELMA for one or more of the following reasons: