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This Form is NOT intended to contact United Therapeutics Corporation’s Medical Information Department or to report suspected Adverse Events. In the event of either, please use the contact information below.
Medical Information: Call 1-877-522-2950 or send requests directly to: DrugInformation@unither.com. Adverse Events: To report a suspected adverse reaction (ADR) to United Therapeutics, please send ADR information to DrugSafety@unither.com, or by faxing the ADR information to 1-919-313-1297, or to report ADRs to the FDA, ADR information can be submitted at 1-800-FDA-1088 or www.fda.gov/medwatch.
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Thank you for your interest in prescribing Remodulin® (treprostinil) injection. This referral form has recently been revised to include the Remunity® Pump for Remodulin, a new subcutaneous delivery pump option for your patients.
United Therapeutics is committed to ensuring the best experience for you and your patients through education and support. To learn more about the pump and considerations prior to prescribing, please request additional information or a visit from a representative using the form below.
Thank you, your request has been received. Please click below to continue to the PDF download.
iAssist allows healthcare providers (HCPs) to submit electronic prescriptions and referral forms, perform advanced benefit verifications, submit real-time electronic prior authorizations, obtain patient electronic consent, and track patient adherence to therapy through portal notifications.
Currently, the 48 mcg (112 ct) and 64 mcg (112 ct) Maintenance Kits (28-day supply) are available for ordering. These strengths correspond with 8-10 breaths and 11-12 breaths with the TYVASO nebulizer, respectively. The remaining Maintenance Kits and Titration Kits will be available soon.
To learn more about TYVASO DPI and Kit availability, please reach out to your local United Therapeutics Cardiopulmonary Specialist.
Prior Authorization Checklist
Request for Support Form
Sample Statement of Medical Necessity
Sample Appeal Letter
Example Referral Form
Veterans Affairs Referral Form
Sample Referral Form
Tyvaso PAH Sample Statement of Medical Necessity
Tyvaso PAH Sample Appeal Letter
Tyvaso DPI Sample Statement of Medical Necessity
Tyvaso DPI Sample Appeal Letter
Tyvaso PH-ILD Sample Statement of Medical Necessity
Tyvaso PH-ILD Sample Appeal Letter
Pharmacisit Information Form
Ordering Unituxin Form
Notice of 340B Contract Pharmacy Policy, Nov. 18, 2020
Letter to Covered Entities with Next Steps and FAQs, Apr. 29, 2021
Data Implementation Notice to Covered Entities, May 11, 2021
Data Implementation Notice to Covered Entities, Jul. 23, 2021
Data Implementation Notice to Covered Entities, Apr. 8, 2022
Application to Designate a Single 340B Contract Pharmacy Location
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