How do I enroll my patient in NuvationConnect™?

To enroll a patient in NuvationConnect™, you may use the electronic Enrollment Form. You can also download and fax the Enrollment Form to 1-877-NUV-CON1 (1-877-688-2661).

How do I enroll my patient in Copay Assistance?

You can enroll your patient in the Copay Assistance Program directly here. Additionally, patients that are enrolled in NuvationConnect™ will automatically be assessed for Copay Assistance eligibility.

How do I enroll my patient in the Patient Assistance Program (PAP)?

To enroll a patient in PAP, use the NuvationConnect™ electronic Enrollment Form. Be sure to complete the necessary additional information for PAP. You can also download and fax the NuvationConnect™ Enrollment Form to 1-877-NUV-CON1 (1-877-688-2661).

Do I need to re-enroll my patient in any of the NuvationConnect™ programs?

Re-enrollment is only required for the Patient Assistance Program. Patients are automatically re-enrolled in all other NuvationConnect™ programs.

HCP Resources & Patient Enrollment Forms

Resources

Connecting you to resources

NuvationConnect^™ provides resources for providers, patients, and caregivers to help along the treatment journey

Frequently asked questions

Downloadable Resources

Enrollment Form

To enroll patients in NuvationConnect, Quick Start, Copay Assistance, Bridge, and Patient Assistance Programs.

Spanish Enrollment Form

Spanish version to enroll patients in NuvationConnect, Quick Start, Copay Assistance, Bridge and Patient Assistance Programs.

Free Trial Request Form

To enroll patients in NuvationConnect Free Trial Offer.

Spanish Free Trial Form

Spanish version to enroll patients in NuvationConnect Free Trial Offer.

Copay Assistance Brochure

Provides an overview of available copay support and detailed eligibility criteria.

Distribution Sheet

Offers key details about IBTROZI™ (taletrectinib), and the specialty pharmacy and distribution networks.

HCP brochure

Gives HCPs and office staff a clear look at the NuvationConnect’s offerings, how to enroll, and additional support.

IBTROZI^™ Coverage Guide

Provides an overview of the access and navigation process for IBTROZI™ (taletrectinib), highlighting available support resources.

LMN Letter

Educational template for offices to reference when navigating a medical necessity request with payers.

Appeal Letter

Educational template for offices to reference when navigating an appeal request with payers.

Patient Brochure

Helps patients understand the support available through the program, steps for enrollment, and additional support.

How do I enroll my patient in NuvationConnect™? Expand

How do I enroll my patient in Copay Assistance? Expand

How do I enroll my patient in the Patient Assistance Program (PAP)? Expand

Do I need to re-enroll my patient in any of the NuvationConnect™ programs? Expand