Select one of the following options
Once you decide UPLIZNA® (inebilizumab-cdon) is right for your patient, it’s easy to start their enrollment in Horizon By Your Side with the Patient Enrollment Form (PEF) and submit it using one of two convenient options. Patient consent will be required.
Simply fill out the form, sign and submit online through DocuSign®.
Fill out the form, then download, sign and fax the form to 1-833-329-8477 OR email it to UPLIZNAHBYS@horizontherapeutics.com.
Once your patient is enrolled, you will receive a comprehensive summary of your patient’s benefits from the Horizon By Your Side team. We will be there to provide support when your patient needs it throughout their treatment journey.