Getting Patients Started
Not an actual patient. Individual results will vary.
Prescribing ILARIS for your appropriate patients
Treatment begins with the ILARIS Start Form
Submit a Start Form in 2 easy steps:
Download, print, and fill out the Start FormAll sections of this form must be completed by the physician, patient, and/or appropriate office staff member only.
The form must be signed by you AND your patient. A missing patient signature will delay the start of program services.
Purpose of the Start Form
- Enrolls the patients in ILARIS Companion
- Serves as the prescription of treatment with ILARIS and provides the option for enrollment into select services
- Identifies eligibility for assistance programs to reduce out-of-pocket costs
Required Information for the Start Form
- Physician AND patient signatures
- ICD-10-CM code
- Number of ILARIS vials
- Number of refills
- Patient’s insurance information
- Dosage and administration instructions
- Place of administration (at home or at a physician’s office)
If patients are unavailable to sign the Start Form, they can provide consent at the HIPAA Consent site.
Acquisition and Reimbursement Guide
This comprehensive guide provides information on acquisition, payer coverage and prior authorization considerations, administration and reimbursement.
Contact Novartis Patient Support
Reach out to the Novartis Patient Support team at 1-866-972-8315 with any questions or for guidance on the ILARIS Companion Support Program
Reference: Data on file. ILARIS Companion CRM Statistics Updates 2023. Novartis Pharmaceuticals Corp; 2023.