Enrollment Form

Complete the Enrollment Form with your patient and fax it to 800-700-5065.

Once enrolled and ready for treatment, patients will receive a Welcome Kit that includes important information to get them started on BESREMi.

Product Fact Sheet and Ordering Information

Explore product information about BESREMi, including our specialty pharmacy and distribution network, as well as storage and handling instructions.

PharmaEssentia SOURCE HCP Guide

How to start your patients on BESREMi.

Sample Letter of Medical Necessity

Verify that the medication you are prescribing is for the treatment of your patient's disease.

Medical Necessity Travel Form

Explain why it is medically necessary for your patient to take BESREMi with them when they fly.

Sample Letter of Appeal

Request a reconsideration after a PA denial.

Sample Formulary Exception Letter

Request that a formulary restriction placed on BESREMi be removed, as it is medically appropriate and necessary for your patient's treatment.

PharmaEssentia SOURCE Patient Guide

Let your patients know about the comprehensive services and support available to them.

Besremi Pen™ Instructions for Use

Review the steps involved in the BESREMi Pen administration process.

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Watch step-by-step instructions on how to use BESREMi Pen.

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BESREMi Prefilled Syringe Instructions for Use

Review the steps involved in the BESREMi syringe administration process.

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Watch step-by-step instructions on how to use BESREMi prefilled syringe.