Here you will find forms and helpful resources for PharmaEssentia SOURCE and BESREMi all in one place.
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.
Explore product information about BESREMi, including our specialty pharmacy and distribution network, as well as storage and handling instructions.
How to start your patients on BESREMi
Verify that the medication you are prescribing is for the treatment of your patient’s disease.
Explain why it is medically necessary for your patient to take BESREMi with them when they fly.
Request a reconsideration after a PA denial.
Request that a formulary restriction placed on BESREMi be removed, as it is medically appropriate and necessary for your patient’s treatment.
Let your patients know about the comprehensive services and support available to them.
Review the steps involved in the BESREMi injection process.
Watch step-by-step instructions on how to inject BESREMi.
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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-2100061 (v6.0) 12/2022
800-700-5053