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  • Example Of Completed Taltz Together Enrollment Form

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Prescription Information and Taltz Together Enrollment Form Complete and fax this form to 18443448108. All fields required, unless noted. For questions or concerns, please call Taltz Together at 1844TALTZNOW.

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Moderate to severe plaque psoriasis. For this use, your doctor may prescribe Taltz if they think your psoriasis would benefit from systemic treatment (therapy that affects your whole body) or phototherapy (light treatment).

Taltz is indicated for adults with active ankylosing spondylitis (AS), for adults with active non-radiographic axial spondyloarthritis (nr-axSpA) with objective signs of inflammation, and for adults with active psoriatic arthritis (PsA).

If you have any other questions, you can call Taltz Together for additional support at 1-844-TALTZ-NOW (1-844-825-8966). Make sure to save the number for Taltz Together in your contacts.

Taltz is approved for the treatment of pediatric patients ages 6 to under 18 with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.

Taltz forms The drug is available in two forms: a single-dose syringe and a single-dose autoinjector.

TALTZ is administered by subcutaneous injection. The recommended dosage is 160 mg (two 80 mg injections) at Week 0, followed by 80 mg at Weeks 2, 4, 6, 8, 10, and 12, then 80 mg every 4 weeks. TALTZ is administered by subcutaneous injection every 4 weeks (Q4W).

Patients must have commercial drug insurance and prescription consistent with FDA-approved product labeling to pay as little as $25 for a 28-day supply of Taltz. Participation in the $25 program requires submission of a prior authorization (PA).

TALTZ is administered by subcutaneous injection. The recommended dosage is 160 mg (two 80 mg injections) at Week 0, followed by 80 mg at Weeks 2, 4, 6, 8, 10, and 12, then 80 mg every 4 weeks. TALTZ is administered by subcutaneous injection every 4 weeks (Q4W).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232