I am a Patient or CaregiverI am a US Healthcare PROFESSIONAL Prescribing InformationImportant Safety Information

Coordinating Delivery

Support in Accessing BESREMi

There are 3 options for prescribing BESREMi:

OPTION

1Complete and submit the PharmaEssentia SOURCE Enrollment Form. It includes a section that serves as your patient’s first prescription.

OPTION

2Prescribe BESREMi for fulfillment through one of our specialty pharmacy partners, including Biologics or Onco360, and the medication will be shipped directly to your patient.

OPTION

3Dispense BESREMi in the office (for oncology GPO members).

img imgProduct Fact Sheet and
Ordering Information

For product information about BESREMi, including specialty pharmacy and distribution network and storage and handling instructions, download this flashcard.

img imgEnrollment
Form

Complete the Enrollment Form to request reimbursement support and indicate your preferred pharmacy.

Fax the Enrollment Form to PharmaEssentia SOURCE at 800-700-5065.

phone iconIf you have any questions about pharmacy qualifications, call PharmaEssentia SOURCE at 800-700-5053 between 8:00 AM and 8:00 PM ET, Monday through Friday.

Find the important forms you need to help your patient get started on BESREMiimgimg