Manufacturer
Sandoz Pharmaceuticals, Inc.
Send your referral electronically
You can send an electronic referral using our prescriber website MyAccredoPatients.com. Simply register or login and navigate to "Send a Referral" on the dashboard. Once logged in, you will be routed to iAssist, which is Accredo’s electronic referral service. If you are not registered for iAssist, you will be prompted to do so.
Alternatively, if you are unable to send an electronic referral, you can download the PDFs below and send to us via fax.
Referral forms for Pulmonary Arterial Hypertension (PAH):
- treprostinil Generic Therapy Referral Form
- treprostinil Generic Pharmacy Prepared Therapy Referral Form
- Remodulin® (treprostinil) Brand Therapy Referral Form
- Remodulin® Premixed Brand Therapy Referral Form
Other required forms:
- Clinical Documentation Requirements/Fax Transmittal Form
- Calcium channel blocker statement
- Statement of Pulmonary Arterial Hypertension Diagnosis
- Statement in Relation to Lung Disease - for patients with certain lung disorders
- Statement in Relation to Sleep Apnea - if clinical notes indicate that pt has a Hx of sleep apnea
- Statement of Transition - for those patients transitioning from another PAH therapy