Get Entyvio Connect Enrollment And Co-pay Forms - Needymeds

This guide provides clear instructions on how to fill out the ENTYVIO CONNECT ENROLLMENT AND CO-PAY FORMS found on Needymeds. Whether you are completing these forms for yourself or on behalf of someone else, following these steps will ensure a smooth submission process.

Follow the steps to complete the forms accurately and efficiently.

1. Locate and use the ‘Get Form’ button to acquire the ENTYVIO CONNECT ENROLLMENT AND CO-PAY FORMS and open the document in your preferred digital editing tool.
2. Begin with the Enrollment Form, ensuring you fill out the Patient Information section. This includes the patient’s name, address, contact numbers, date of birth, and email. Remember to attach an enlarged copy of both sides of the patient's insurance card and pharmacy benefit card, if available.
3. Complete the Patient Authorization and Co-Pay Consent Form by having the patient read it thoroughly and provide their signature. Although signing may not be mandatory for receiving Entyvio, it is advisable for expediency in obtaining therapy reimbursement and support services.
4. If the patient’s insurance plan necessitates that the medication is dispensed by a specialty pharmacy, provide the necessary prescription information. Entyvio Connect will guide you to the appropriate specialty pharmacy based on the insurance plan details.
5. Ensure all necessary sections are duly filled out and that signatures are placed in the highlighted areas of the forms. It's essential to double-check for accuracy before faxing.
6. Fax the completed forms along with copies of the patient’s insurance card and pharmacy benefit card, if applicable, to 1-877-488-6814.
7. Finally, encourage the patient to reach out to the Entyvio Connect helpline at 1-855-ENTYVIO (1-855-368-9846) for any questions, available Monday to Friday, from 8 AM to 8 PM EST.

Start completing the ENTYVIO CONNECT ENROLLMENT AND CO-PAY FORMS online today to ensure timely access to necessary medication and support.