Samples & patient savings
IBSA Pharma is committed to supporting healthcare professionals in their mission to treat patients. IBSA offers the following support material to medical professionals and their staffs:
To order samples of Tirosint, click the link below and follow the directions. Please note that any Sample Request Forms must be signed by a healthcare professional who is licensed to prescribe medication in the United States. In most cases, samples will be shipped within 3 business days after receipt of a fully completed Sample Request Form. There is a limit of one sample shipment per month, per licensed prescriber.
Click here for a Tirosint Sample Request Form.
Patient information and copay savings
A variety of Tirosint patient support material is available for your practice including:
- Patient brochure explaining hypothyroidism and Tirosint
- Administration instructions
- Copay Savings Card
You will automatically receive a quantity of patient support material when you order Tirosint samples. If you are only interested in receiving patient support material, please contact us at firstname.lastname@example.org.
Request a IBSA Sales Representative
You can request a Tirosint sales representative at email@example.com.
Prescribing via Tirosint Direct Program
The Tirosint Direct Program provides your patients with the opportunity to purchase their Tirosint therapy at the lowest cash price available. The ordering process is fast and easy. You can send your prescriptions to one of the Tirosint Direct participating mail order pharmacies either by e-prescribing or by fax.
Who can benefit from the Tirosint Direct Program?
Any patient who wants to save money on their Tirosint prescription can benefit from the Tirosint Direct Program. Patients without commercial insurance, those with high copays or deductibles, or who are paying cash for their prescriptions (including Medicare Part D patients paying cash) can purchase Tirosint at a significant discount compared to traditional retail pharmacies. Even patients with commercial health insurance can benefit from the program as their prescriptions can be dispensed using their insurance program or paid for with cash. In either case, customer service agents will advise patients as to which option will provide them with the lowest out-of-pocket cost for their prescription.
Advantages of the Tirosint Direct Program for your practice
The Tirosint Direct Program can save time for you and your office staff. Mail order pharmacies participating in the program offer the following services:
- Insurance verification and Prior Authorization Assistance
- Fast and accurate door-to-door delivery
- Refill reminders for patients
- Prescriber information
- Prescriber order form
- Patient information
- Highland ships to all states except:
- West Virginia
- Contact Highlands Specialty Pharmacy:
Toll free 855-894-4441
To send a prescription electronically, use one of the following codes: NABP is 2588842 OR 601.268.6033 OR Highland Specialty – Hattie
- Click here for more information
- Click here to order
- For California and Massachusetts
- Contact Delta Drugs:
To add Delta Drugs Pharmacy to your EMR system, use the following information:
a. Delta Drugs Pharmacy 437 Fernando Ct Glendale, CA 91204 OR
b. NPI: 1790036671
Please write in the Notes section: Ok to do PA
Add patient social security number on the e-script.
- Prescriber information
- Prescriber fax order form
- Patient information
- Transition Pharmacy ships to all 50 states and U.S. territories
- Contact Transition Pharmacy:
To send a prescription electronically, use one of the following codes: NCPDP: 3989603 OR NPI: 1336325265 (City: Feasterville-Trevose, Zip 1
For medical information please call 800-587-3513 or email firstname.lastname@example.org.
Click here for an IBSA Pharma Medical Information Request Form.
To Report Adverse Events
To report an adverse event or product quality complaint please call 800-587-3513 or email email@example.com.
Patient Assistance Program (PAP)
IBSA offers a patient assistance program providing IBSA brand name medications to individuals who meet eligibility requirements. Eligibility is based on your annual household income and prescription insurance status. To see if you are eligible, complete and return the enrollment form. If you qualify, you will automatically be mailed your first 30-day supply. You will then be eligible to receive free medicine(s) for up to one year by calling to refill your prescription every month. You must re-enroll each year to remain in the program.
For more information on eligibility and how to enroll, visit www.ibsapap.com.