RESOURCES
A Library of Resources Is Available to Help
You, Your Patients, and Your Office at
Every Stage of the OXERVATE® Journey
For eye care professionals and office staff
Prescription resources
Patient Enrollment Form
OXERVATE prescription and patient enrollment form
Patient Authorization Form (English and Spanish)
Patient consent form to be used when E-prescribing
Access resources
Access Overview Brochure
An overview of the access process and financial assistance support programs
Dompé CONNECT to Care Access and Fulfillment Guide
A comprehensive guide to OXERVATE prescription and treatment through Dompé CONNECT to Care, focused on the needs of the office staff
Accredo Specialty Pharmacy Access and Fulfillment Guide
A comprehensive guide to OXERVATE prescription and treatment through Accredo, focused on the needs of the office staff
Appeal resources
Letter of Medical Necessity
Sample document to provide guidance on communicating clinical rationale and the need for treatment access
Appeal Letter Guide
Sample appeal letter used to provide guidance on the OXERVATE appeal process
Prior Authorization (PA) Checklist
Reference guide detailing the most common health plan requirements for PA to help ensure complete and accurate submissions
For patients
Getting your patients started on OXERVATE
Dompé CONNECT to Care Patient Access Guide
A resource to help patients understand what to expect during the approval process for OXERVATE, with a dedicated Dompé CONNECT to Care team available to answer questions and provide support
Accredo Specialty Pharmacy Patient Access Guide
A guide to help patients learn about Accredo and how your office uses it to get them started on OXERVATE faster
Patient education
Patient Brochure
Patient-friendly overview of neurotrophic keratitis (NK), OXERVATE, and the access process
OXERVATE Administration Video (English and Spanish)
Important instructions for dosing and administering OXERVATE