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Use these convenient resources to help start your appropriate patients on TEPEZZA, manage coding and billing details, help patients with access and coverage, and deliver patient education.
Take the next step and submit a Patient Enrollment Form (PEF) for TEPEZZA® (teprotumumab-trbw). Start the enrollment process in Amgen By Your Side on your patient’s behalf using one of two convenient options. Patient consent will be required to complete enrollment.
Patient
Enrollment Form
Download the form, complete it with your patient, including HCP and patient signatures, and submit by fax or email. Bookmark this page for next time!
DocuSign® eSignature Patient Enrollment Form
Complete the form and send to your patient via email to sign electronically via DocuSign®.
1+1 Checklist
A checklist for evaluating the core signs/symptoms and present triggers that signal time to treat Thyroid Eye Disease (TED).
Patient Intake Form
A form designed to help evaluate patients you suspect may have TED or to assess the full impact on their quality of life.
TEPEZZA At Your Practice
A guide to clinical, access, and reimbursement considerations for TEPEZZA
Clinical Documentation Guide
A guide to documenting TED symptomatology with a focus on capturing key clinical criteria, such as Clinical Activity Score (CAS).
Clinical Documentation Tearpad
A form that outlines the CAS that is used to evaluate the inflammatory signs and symptoms of TED.
Letter of Medical Necessity Template
A customizable template for a letter of medical necessity to support prior authorization (PA) for TEPEZZA.
Payer Appeal Letter Template
A customizable appeals template for patient cases that were denied PA.
TEPEZZA Comprehensive Access Guide
A one-stop resource that will help you and your patients navigate access and support for TEPEZZA.
Product Fact Sheet
Product information, including NDC, packaging, storage, handling, and authorized distributor list.
Billing and Coding Guide
A guide to billing procedures, necessary codes, and reimbursement with J-code.
Infusion Manual
A detailed guide to preparing, administering, and infusing TEPEZZA.
Infusion Administration Video
Key steps required for reconstitution, dilution, and administration of TEPEZZA.
Getting Started on Tepezza Patient Brochure
A brochure to guide your patients through the initial steps of getting started on TEPEZZA.
Getting Started on Tepezza Video
A video to help your patients understand how to get started on TEPEZZA.
Tepezza Insurance Approval Guide
A brochure to guide your patients through insurance coverage and approval of TEPEZZA.
Tepezza Pre-Infusion Reminder List
A list that helps your patients prepare for TEPEZZA infusions.
Tepezza Post-Infusion Reminder List
Answers to common questions about home infusion for TEPEZZA.
