Specialty Pharmacy Enrollment Forms
Our interactive enrollment forms make sending prescriptions easy. Simply download the fillable form, type or print the appropriate information and return to US Specialty via fax – (800) 530 8589.
Once we receive the completed disease-specific enrollment form, US Specialty will:
- Verify and coordinate insurance coverage
- Provide prior authorization and financial assistance
- A Patient Care Advocate will be assigned to the patient to coordinate medication delivery and assist with questions and medication compliance