Αποτελέσματα Αναζήτησης
To order Kyleena, Mirena or Skyla, complete the Specialty Pharmacy Prescription Request Form as follows: 1. Select Specialty Pharmacy. 2. Enter the patient and prescriber information in the space provided on the Specialty Pharmacy Prescription Request Form, including the patient’s pharmacy drug benefit and medical insurance information.
Browse Mirena® (levonorgestrel-releasing intrauterine system) 52 mg IUD resources for you, your staff, & your patients. See full prescribing and safety info.
Forms. Click below for additional information on ordering and reimbursement forms for Kyleena, Mirena, and Skyla. Learn More. Bayer can help your patients. with product costs. Bayer offers a patient assistance program that provides Kyleena, Mirena and Skyla Intrauterine Devices at no cost for eligible patients. Learn More.
WHC Support Center Forms. Ordering and Reimbursement for Kyleena, Mirena, and Skyla
To order Mirena®, complete the Prescription Form as follows: 1. Enter the patient and health care provider information in the space provided on the Prescription Request Form
please fax the prescription request form, including the signed patient authorization section on this page. Please see Important Safety Information for Kyleena, Mirena or Skyla on third page and accompanying full Prescribing Information for Kyleena, Mirena and Skyla.
This form should be used whenever a patient needs to request a prescription for Kyleena, Mirena, or Skyla from their healthcare provider. It is essential for ensuring all necessary information is communicated effectively between the patient and pharmacy. 1. For New Prescriptions: To request a new intrauterine system for contraception.
