Coverage and insurance support
Provide comprehensive support for insurance coverage including verification of benefits, assistance with prior authorizations, guidance through the appeals process, and education on payer requirements.
EGRIFTA WRTM
EGRIFTA SV®
Welcome to the THERA patient support® program!
Here for you and your EGRIFTA® patients every step of the way!
Benefits to Patients Prescribed EGRIFTA WRTM or EGRIFTA SV® Enrolled in the THERA patient support® Program
Financial Assistance Program to help cover the cost of care*
Commercial Insurance
The THERA Co-Pay Program may help patients with private or commercial insurance lower their out‑of‑pocket costs.
Government Insurance
THERA patient support® can assist with alternative funding for patients with government insurance that may lower their out‑of‑pocket costs.
Patient Assistance Program
The THERA Patient Assistance Program offers qualifying patients THERA medications at no cost.
Injection training with a THERA Nurse Navigator
Guaranteed personalized injection training by one of our experienced THERA patient support® Nurse Navigators. Training is available virtually through telephone or video calls.
* The Financial Assistance Program is available only for eligible patients.
CHOOSE THE MEDICATION YOU ARE PRESCRIBING:
Use the drop‑down menu below to explore THERA patient support® program resources designed to help you, your staff, and your patients with enrollment, services, treatment access, and more.
For questions on enrolling your patients and getting them started on EGRIFTA WRTM or EGRIFTA SV®, call the THERA patient support® line at 1‑833‑23THERA (1‑833‑238-4372) and a THERA patient support® Patient Care Coordinator will assist you with any questions.
Available Monday to Friday from 8:30 AM – 8:00 PM EST.
Enrollment Form
The EGRIFTA SV® Enrollment Form is the first step to getting patients started with the THERA patient support® program.
Available in English and Spanish.
Need assistance filling out the Enrollment Form? Call THERA patient support® at 1‑833‑23THERA (1‑833‑238-4372). Available Monday to Friday from 8:30 AM – 8:00 PM EST.
Patient Digital Consent
To ensure your patients can immediately get started on EGRIFTA SV® therapy, it is important to obtain patient consent. Patients can provide consent by signing the last page of the enrollment form. If your patient is unable to sign the back of the enrollment form, share the link below so they can provide their consent digitally.
Letter of Medical Necessity
A simple, fillable PDF template to help healthcare providers justify their patient’s need for EGRIFTA SV® to the patient’s health insurance company.
Prior Authorization Checklist
A comprehensive list for healthcare providers to reference to ensure they have provided the necessary information and documentation to complete a prior authorization request form for EGRIFTA SV® to the patient’s health insurance company.
Letter of Appeal
A fillable PDF template to be completed by healthcare providers to appeal or challenge a denied insurance claim for EGRIFTA SV®.
The Physician Portal
The Physician Portal allows healthcare providers to seamlessly enroll patients online, upload the signed patient consent form and chart notes, track patients’ real‑time enrollment status, obtain coverage information, and view the EGRIFTA SV® shipment information.
THERA patient support® Healthcare Professional Brochure
A comprehensive summary of the services offered by the THERA patient support® program to you and your patients on EGIRFTA SV® therapy.
THERA patient support® Patient Brochure
A comprehensive patient guide on the services offered by the THERA patient support® program to support them on their EGRIFTA SV® treatment journey.
For questions on enrolling your patients and getting them started on EGRIFTA SV®, call the THERA patient support® line at 1‑833‑23THERA (1‑833‑238-4372) and a THERA patient support® Patient Care Coordinator will assist you with any questions.
Available Monday to Friday from 8:30 AM – 8:00 PM EST.
Questions about EGRIFTA SV®?
Enrollment Form
The EGRIFTA WRTM Enrollment Form is the first step to getting patients started with the THERA patient support® program.
Available in English and Spanish.
Need assistance filling out the Enrollment Form? Call THERA patient support® at 1‑833‑23THERA (1‑833‑238-4372). Available Monday to Friday from 8:30 AM – 8:00 PM EST.
Patient Digital Consent
To ensure your patients can immediately get started on EGRIFTA WRTM therapy, it is important to obtain patient consent. Patients can provide consent by signing the last page of the enrollment form. If your patient is unable to sign the back of the enrollment form, share the link below so they can provide their consent digitally.
Letter of Medical Necessity
A simple, fillable PDF template to help healthcare providers justify their patient’s need for EGRIFTA WRTM to the patient’s health insurance company.
Prior Authorization Checklist
A comprehensive list for healthcare providers to reference to ensure they have provided the necessary information and documentation to complete a prior authorization request form for EGRIFTA WRTM to the patient’s health insurance company.
Letter of Appeal
A fillable PDF template to be completed by healthcare providers to appeal or challenge a denied insurance claim for EGRIFTA WRTM.
The Physician Portal
The Physician Portal allows healthcare providers to seamlessly enroll patients online, upload the signed patient consent form and chart notes, track patients’ real‑time enrollment status, obtain coverage information, and view the EGRIFTA WRTM shipment information.
Coming Soon
THERA patient support® Healthcare Professional Brochure
A comprehensive summary of the services offered by the THERA patient support® program to you and your patients on EGRIFTA WRTM therapy.
Coming Soon
THERA patient support® Patient Brochure
A comprehensive patient guide on the services offered by the THERA patient support® program to support them on their EGRIFTA WRTM treatment journey.
For questions on enrolling your patients and getting them started on EGRIFTA WRTM, call the THERA patient support® line at 1‑833‑23THERA (1‑833‑238-4372) and a THERA patient support® Patient Care Coordinator will assist you with any questions.
Available Monday to Friday from 8:30 AM – 8:00 PM EST.
Questions about EGRIFTA WRTM?