5 Easy Steps To Complete Fasenra Enrollment Form

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Fasenra, a medication used to treat severe asthma, has been a game-changer for many patients. However, to access this life-changing treatment, patients and healthcare providers must complete the Fasenra enrollment form. This process can seem daunting, but fear not! In this article, we will break down the Fasenra enrollment form into 5 easy steps, making it simple and straightforward for you to complete.

What is Fasenra and Why Do I Need to Enroll?

Before we dive into the enrollment process, let's quickly discuss what Fasenra is and why enrollment is necessary. Fasenra (benralizumab) is a prescription medication used to treat severe asthma in patients 12 years and older. It is administered via injection every 4 weeks for the first 3 doses, and then every 8 weeks thereafter. To ensure that patients receive this medication safely and effectively, the manufacturer, AstraZeneca, requires enrollment in their patient support program.

Step 1: Gather Required Information

Before starting the enrollment process, gather all necessary information and documents. You will need:

• Patient's demographic information (name, date of birth, address, etc.)
• Patient's medical history, including asthma diagnosis and treatment
• Insurance information (health insurance card, policy number, etc.)
• Healthcare provider's information (name, address, phone number, etc.)

Step 2: Choose Your Enrollment Method

You can enroll in the Fasenra patient support program in one of two ways:

• Online Enrollment: Visit the AstraZeneca website and fill out the online enrollment form. This method is quick and easy, and you will receive instant confirmation of your enrollment.
• Phone Enrollment: Call the AstraZeneca patient support hotline and speak with a representative who will guide you through the enrollment process.

Step 3: Complete the Enrollment Form

Once you have chosen your enrollment method, complete the Fasenra enrollment form. The form will ask for the information you gathered in Step 1. Be sure to answer all questions accurately and thoroughly.

• Section 1: Patient Information: Provide patient demographic information, medical history, and insurance details.
• Section 2: Healthcare Provider Information: Provide healthcare provider information, including name, address, and phone number.
• Section 3: Treatment Information: Provide information about the patient's Fasenra treatment, including dosage and administration schedule.

Step 4: Review and Submit the Enrollment Form

Carefully review the completed enrollment form to ensure all information is accurate and complete. If you are enrolling online, click the "Submit" button to send the form to AstraZeneca. If you are enrolling by phone, the representative will review the form with you and submit it on your behalf.

Step 5: Receive Confirmation and Support

After submitting the enrollment form, you will receive confirmation of enrollment and information about the patient support program. The program offers various resources, including:

• Nurse Support: Dedicated nurses who can answer questions and provide support throughout treatment
• Patient Education: Educational materials and resources to help patients understand their treatment and manage their condition
• Access to Fasenra: Assistance with accessing Fasenra, including reimbursement support and co-pay cards

By following these 5 easy steps, you can complete the Fasenra enrollment form and access this life-changing treatment for severe asthma.

Don't Forget to Share Your Experience!

We hope this article has made the Fasenra enrollment process easier for you. If you have any questions or would like to share your experience with the enrollment process, please comment below. Share this article with others who may benefit from this information, and let's work together to support those living with severe asthma.

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