PharmaEssentia SOURCE offers personalized support services designed to help you successfully start and stay on BESREMi (ropeginterferon alfa-2b-njft).
1. Download and print the Enrollment Form to complete, sign, and date your portion, then give it to your doctor.
2. Your doctor completes, signs, and dates their portion.
3. Your doctor faxes the completed form to 800-700-5065.
Your PharmaEssentia SOURCE Case Manager will call you to discuss the next steps.
Our dedicated PharmaEssentia SOURCE Case Managers are here to help you:
between 8:00 AM and 8:00 PM ET, Monday through Friday.
Your dedicated PharmaEssentia SOURCE Case Manager can guide you through the injection process and help you understand the correct dosage of BESREMi during your treatment.
It’s important to know you’re not alone. Our PharmaEssentia SOURCE Case Managers are here to support you every step of the way. You can also get more resources and support from advocacy groups.
© 2022 PharmaEssentia Corporation. All rights reserved.
BESREMi, the BESREMi logo, and PharmaEssentia are registered
trademarks of PharmaEssentia Corporation, and the PharmaEssentia
logo, PharmaEssentia SOURCE, and the PharmaEssentia SOURCE logo
are trademarks of PharmaEssentia Corporation. US-BSRM-2100060
(v4.0) 12/2022
800-700-5053
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