PA Request Form Checklist
This checklist can help you take the guesswork out of prior authorization and reauthorization paperwork.
This checklist can help you take the guesswork out of prior authorization and reauthorization paperwork.
Fax the completed form along with a copy of the front and back of your patient's insurance card(s).
Fax to
Takeda provides both in-home and virtual self-infusion training through our third-party nurse vendor Specialty Pharmacy Nursing Network, Inc. (“SPNN”) when authorized by a patient's healthcare provider. Takeda provides this training at no cost to patients enrolled in HSC. In addition, your patient may receive up to 5 training sessions.
To learn more about this service and to provide your authorization for your patient to receive training, you’ll need to download and complete the authorization form below. If you have questions, please call HSC at
Download Physician Authorization Form for in-home or virtual self-infusion training.
Download the following resources to help your patients get access to their prescribed Takeda therapy when potential insurance challenges arise.
This guide offers information to help you navigate and respond to appeals and denials for Takeda hematology product coverage.
This guide offers information to help you navigate and respond to appeals and denials for Takeda hematology product coverage.
HSC provides sample Letters of Medical Necessity for specific Takeda hematology therapies. You can find them by visiting the Product Information and Coding section.
HSC provides sample Letters of Medical Necessity for specific Takeda hematology therapies. You can find them by visiting the Product Information and Coding section.
Find links, worksheets, and guides to help your patients understand bleeding disorders and the complex landscape of health insurance.
Information to help patients learn about bleeding disorders and connect with others.
Insightful articles and free downloads from the CDC.
Tools and resources to help patients self-advocate and connect with others.
A search tool to help patients find an HTC near them.
Provides the latest news about bleeding disorders, resources for navigating insurance, advocacy tools, and more.
Medicare
The Centers for Medicare and Medicaid Services (CMS)
Veterans Health Administration