Qbrelis^® Prior Authorization Tools

Advocating for your patients in important prior authorization conversations.

Three tools for PA

Helping you focus less on paperwork and more on patients.

Option 1:

Start the prior authorization process with CoverMyMeds®, a third-party online resource for prior authorization paperwork

Option 2:

If needed, the prior authorization hotline is an additional resource to advocate for your patients

844-472-2032

Option 3:

If insurance approval takes more than 48 hours, the Bridge Drug Program may help cover the gap

Start a CoverMyMeds® form

Call for support

Prior Authorization
Insurance Verification
Bridge Drug Program
Patient Assistance and Resources
Product Information

844-472-2032

Prior authorization support hotline is provided by a third-party vendor

Forms

Prior Authorization Hotline Form

Download Patient Enrollment and Prescription Form PDF

Patient Assistance Program Form

Download Eligibility Criteria PDF

Learn more about Qbrelis®

Comprehensive patient support for Qbrelis^® (lisinopril), from office to pharmacy

Prior Authorization (PA)
Tools

Co-pay Savings

Additional Assistance

Qbrelis^® Prior Authorization Tools

Advocating for your patients in important prior authorization conversations.

Three tools for PA

Option 1:

Option 2:

Option 3:

Start a CoverMyMeds® form

Call for support

Forms

Prior Authorization Hotline Form

Patient Assistance Program Form

Comprehensive patient support for Qbrelis® (lisinopril), from office to pharmacy

Prior Authorization (PA) Tools

Co-pay Savings

Additional Assistance

Qbrelis® Prior Authorization Tools

Advocating for your patients in important prior authorization conversations.

Three tools for PA

Option 1:

Option 2:

Option 3:

Start a CoverMyMeds® form

Call for support

Forms

Prior Authorization Hotline Form

Patient Assistance Program Form

Comprehensive patient support for Qbrelis^® (lisinopril), from office to pharmacy

Prior Authorization (PA)
Tools

Qbrelis^® Prior Authorization Tools