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Patient Enrollment
Electronic Prescription and Prior Authorization
Electronic prescriptions and prior authorizations are easy with ePrescribe and CoverMyMeds.
You and your patient will enjoy the convenience!
- You save time, staffing and supplies costs.
- Our pharmacists and clinicians are available to your patients via phone 24/7 and through BriovaLive video consults Monday - Friday.
- Your patients get free shipping to anywhere in the United States.
- Electronic prior authorization (ePA) submission is available through CoverMyMeds Opens in a new window.
- Count on accuracy, safety and service!
Download Enrollment Forms
| Condition | Fillable PDF |
|---|---|
| Crohn’s/Ulcerative Colitis Disease | Fillable PDF |
| Cystic Fibrosis | Fillable PDF |
| Dermatology | Fillable PDF |
| Enzyme Replacement Therapy | Fillable PDF |
| General Enrollment | Fillable PDF |
| Growth Hormone | Fillable PDF |
| Hematopoietic | Fillable PDF |
| Hemophilia | Fillable PDF |
| Hepatitis C | Fillable PDF |
| HIV | Fillable PDF |
| Hyperlipidemia | Fillable PDF |
| Immune Globulin Therapy | Fillable PDF |
| Infertility (General)* | Fillable PDF |
| Makena | Fillable PDF |
| Multiple Sclerosis | Fillable PDF |
| Neuromuscular Therapy | Fillable PDF |
| Oncology-Oral/Infusable-Injectable | Fillable PDF |
| Oncology-Revlimid, Pomalyst, Thalomid | Fillable PDF |
| Ophthalmology | Fillable PDF |
| Osteoarthritis | Fillable PDF |
| Osteoporosis | Fillable PDF |
| Pulmonary Arterial Hypertension | Fillable PDF |
| Rheumatology | Fillable PDF |
| RSV Regular Referral | Fillable PDF |
| Sublocade | Fillable PDF |
| Transplant | Fillable PDF |
| Optum Specific Forms | Fillable PDF |
|---|---|
| Injectable Psychotropic - Optum | Fillable PDF |
| Neuromuscular - Optum - Achalasia, Chronic Anal Fissure, Detrusor Overactivity, Spasticity & Bleopharospasm | Fillable PDF |
| Neuromuscular - Optum - Migraine, Cervical Dystonia & Overactive Bladder | Fillable PDF |
| RSV - Optum | Fillable PDF |
ePrescribe and ePA
Send us prescriptions and prior authorizations electronically.
Conditions
To learn about our key areas of care, select a condition.
Need Assistance
A member of our team can help answer any questions you have.
Call us at 1-855-4BRIOVA
(1-855-427-4682)
Email us at BRxProviderHelp@briovarx.com