Helpful resources and downloadable assets to support your practice and your patients

Patient Enrollment Form

Download the form, complete it with your patient, including HCP and patient signatures, and submit by fax or email.

COMPLETE THE PDF

DocuSign® eSignature Patient Enrollment Form

Complete the form and send to your patient via email to sign electronically via DocuSign®.

DOCUSIGN®

Treatment initiation resources

Helpful information to consider when selecting a site of care for your patient’s TEPEZZA infusion.

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A customizable letter used to notify co-managers and coordinate patient monitoring when TEPEZZA is initiated.

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A customizable template for a TEPEZZA infusion order.

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A guide designed to help you write the infusion order for TEPEZZA.

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Icon of Site of Care (SOC) video

Provides SOCs with insights for integrating TEPEZZA into their practice.

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Answers to common questions about home infusion for TEPEZZA.

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Considerations for choosing home infusion for TEPEZZA.

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Payor access resources

A guide to documenting TED symptomatology with a focus on capturing key clinical criteria such as Clinical Activity Score (CAS).

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This form outlines the CAS that is used to evaluate the inflammatory signs and symptoms of TED.

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Interactive tool to outline the approval process, benefits investigation, letter of medical necessity, prior authorization (PA), and appeals best practices.

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Key considerations for patient access, coordinating care with the prescribing office, and reimbursement.

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A customizable letter of medical necessity template to support PA for TEPEZZA.

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A customizable appeals template for patient cases that were denied PA.

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Billing and coding resources

A guide to TEPEZZA specialty distributors, specialty pharmacies, and ordering.

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Product information, including NDC, packaging, storage, handling, and authorized distributor list.

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A guide to billing procedures, necessary codes, and reimbursement with J-code.

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A guide to necessary codes for billing and reimbursement with J-code.

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Infusion resources

A step-by-step checklist for the infusion process.

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A detailed guide to preparing, administering, and infusing TEPEZZA.

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Icon of Infusion administration video

Key steps required for reconstitution, dilution, and administration of TEPEZZA.

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Patient education resources

An educational brochure for prospective patients to learn more about TEPEZZA.

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A brochure to guide your patients through the initial steps of getting started on TEPEZZA.

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Icon of Getting started on TEPEZZA video

A video to help your patients understand how to get started on TEPEZZA.

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A brochure that addresses patients’ frequently asked questions about home infusion.

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logoFor additional resources for your practice and patients, please visit Horizon By Your Side.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

IMPORTANT SAFETY INFORMATION

Warnings and Precautions

Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.

Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.

Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be managed with medications for glycemic control, if necessary. Monitor patients for elevated blood glucose and symptoms of hyperglycemia while on treatment with TEPEZZA. Patients with preexisting diabetes should be under appropriate glycemic control before receiving TEPEZZA.

Adverse Reactions

The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, and menstrual disorders.

Please see Full Prescribing Information for more information.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

IMPORTANT SAFETY INFORMATION

Warnings and Precautions

Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.

Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.

Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be managed with medications for glycemic control, if necessary. Monitor patients for elevated blood glucose and symptoms of hyperglycemia while on treatment with TEPEZZA. Patients with preexisting diabetes should be under appropriate glycemic control before receiving TEPEZZA.

Adverse Reactions

The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, and menstrual disorders.

Please see Full Prescribing Information for more information.