Support plus form 2026

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The document is a START Form for prescribing Otezla (apremilast), a medication for moderate to severe plaque psoriasis and active psoriatic arthritis. It outlines the steps for completing the form, including patient and insurance information, clinical details, prescription specifics, and prescriber authorization. Additionally, it provides guidance on submitting the form to a specialty pharmacy, obtaining prior authorization if necessary, and accessing support services through Otezla SupportPlus. Important safety information regarding potential side effects and contraindications of Otezla is also included.

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Click 'Get Form' to open the support plus form in the editor.
Begin with Section 1: Patient Information. Fill in your name, date of birth, address, email, and contact numbers. Ensure all fields are completed to avoid processing delays.
Move to Section 2: Insurance Information. Provide details about your primary insurance, including policy and group numbers. If applicable, indicate if you have secondary insurance.
In Section 3: Clinical Information, this section is for healthcare providers. They will need to enter diagnosis codes and treatment history.
Proceed to Section 4: Prescription Information. Healthcare providers should select the appropriate prescription options for Otezla and provide any special instructions.
Finally, complete Section 5: Prescriber Information. The prescriber must sign and date the form before submission.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the Amgen Support Plus program?

The Amgen SupportPlus Co-Pay Program can help eligible commercially insured patients lower their out-of-pocket prescription costs, including deductible, co-insurance, and co-payment. *Eligibility criteria and program maximums apply. See .amgensupportplus.com/copay for full Terms and Conditions.

How do I enroll in Amgen SupportPlus?

Patients can enroll/reenroll by calling (866) 264-2778. Please click here for full Prescribing Information for the listed products.

Who is Amgen support?

Amgen By Your Side is a support program for patients prescribed an Amgen rare disease medication. After your patient has enrolled, they will be paired with a dedicated support partner, called a Patient Access Liaison (PAL) or Clinical Nurse Educator (CNE).

What is Amgen Support Plus?

Amgen Safety Net Foundation offers replacements for physician-administered medications. Under this model, physicians administer Amgen medicines from their existing commercial stock to enrolled Foundation patients and then requests replacement for this medicine from the Foundation.

Who is eligible for Amgen support?

If you have private or commercial insurance that you get from your employer or buy directly from an insurance company, you may be eligible for the Amgen SupportPlus Co-Pay Program.

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