SC Assist 2026

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The document outlines the ORENCIA® SC Assist program, which provides support for patients using subcutaneous ORENCIA, including assistance with insurance coverage and free medication for eligible patients. It includes sections for patient and physician information, authorization agreements, and important safety information regarding the use of ORENCIA for treating rheumatoid arthritis and other conditions. The document also details terms and conditions for the Commence Rx program, emphasizing eligibility criteria and patient privacy.

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Click ‘Get Form’ to open the SC Assist document in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, contact details, and insurance information as required. Ensure all fields marked as required are completed.
Next, move to the 'Physician' section. The physician must provide their name, license number, and facility details. This section is crucial for verifying treatment eligibility.
In the 'Assistance Requested' area, select the appropriate options for benefits review or prior authorization. If applicable, complete the ORENCIA Commence Rx Program section.
Finally, ensure that both the patient and physician sign where indicated. Review all entries for accuracy before submitting.

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