Helpful Resources Banner - Turalio HCP

Forms & Resources

Tools and forms to assist with patient access and support for TURALIO

Logo for Turalio(R)(pexidartinib) 200 mg capsules

Helpful Resources - TURALIO HCP

Patient Enrollment Form (English) Patient Enrollment Form (Spanish)

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

Sample Letter of Appeal

Prior Authorization Checklist

Peer-to-Peer Checklist

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 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.