A TRUSTED APPROACH TO PATIENT ADHERENCE AND SUPPORT
For more than 20 years, Teva’s Shared Solutions® has partnered with your practice and your patients, helping them start and stay committed to therapy.
Prescription and Service Request (PSR) Form
Submitting up-to-date COPAXONE® Prescription & Service Request Forms is the first step for your patients to receive adherence and educational support from Teva's Shared Solutions® during their COPAXONE® therapy.
- When prescribing COPAXONE®, both new prescriptions and refills, download the latest Prescription & Service Request Form.
- Your patient (or authorized representative) must read, sign, and date the Patient Authorization section.
- In the Prescriber Signature section, indicate Dispense as Written (DAW) to help ensure your patients receive COPAXONE® as prescribed, rather than a generic option, from the pharmacy.
- Submit completed forms via fax to 1-800-775-5834.
Letter of Medical Necessity
A template of a letter payers may require to establish medical necessity.DOWNLOAD TEMPLATE
A template of a letter payers may require to appeal a denial of coverage.DOWNLOAD TEMPLATE
Patient training and adherence support
Compassionate, professional nurse support helps patients stay compliant throughout their therapy experience.
- Injection training: Teva-trained nurses provide free, in-home, 1-on-1 injection training when starting or switching to COPAXONE®. Sessions address proper injection technique, injection site rotation, and tips to help manage ISRs and maintain healthy skin.
- Learn more on the COPAXONE® patient site.
- Phone support: Teva nurses are available for personalized phone guidance and support. COPAXONE® patients may speak to a nurse by calling 1-800-887-8100.
- COPAXONE iTracker® 2.0: The improved mobile app for Apple® and Android™ helps patients track their injections, manage injection site rotation, and stay committed to therapy. Features include:
- Injection calendar with personalized reminders
- Injection site rotation tracking and guidance
- Journal for recording and organizing injection notes
- Direct connection to Teva’s Shared Solutions® phone support
- Video injection tutorials and helpful tips
- Learn more on the COPAXONE® patient site, and suggest your patients download COPAXONE iTracker® 2.0 from the App Store® or Google Play™.
- autoject®2 for glass syringe: Available free with a prescription through Teva's Shared Solutions®. This device hides the needle and delivers therapy with a light button press.