Access 360 General Patient Authorization Form (PAF)

Find the right resources to assist your LUMOXITI patients

LUMOXITI Enrollment Form

LUMOXITI 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.

Access 360 General Patient Authorization Form (PAF)

LUMOXITI Coding Resource

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

LUMOXITI C-Code Flashcard

LUMOXITI C-Code Flashcard

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

LUMOXITI Distribution Sheet

LUMOXITI Distribution Sheet

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

LUMOXITI Affordability Brochure

LUMOXITI Affordability Brochure

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