1-866-4-DSI-NOW Helpful Resources Banner - Turalio HCP
Helpful Resources - TURALIO HCP
Patient Enrollment Form (English)
When sent along with the prescription, this form allows Biologics to determine coverage and assess eligibility for financial assistance programs. This form requires a patient’s or representative’s signature.
Sample Letter of Medical Necessity
Visit the TURALIO REMS Program website 
TURALIO is only available through a restricted program under a REMS because of the risk of hepatotoxicity. Prescribing physicians should visit www.turalioREMS.com or call 1-833-887-2546 for information on the program.
The completion and submission of coverage-related documentation are the responsibility of the patient and healthcare provider. Daiichi Sankyo, Inc. makes no representation or guarantee concerning coverage or reimbursement for any service or item. A completed form includes signatures from both the physician and the patient. Before submitting, please ensure all required information is provided.