Patient holding BAFIERTAM support pamphlet for Multiple Sclerosis patients.

Helpful Resources for Your
Office
and Patients

Patient holding BAFIERTAM support pamphlet for Multiple Sclerosis patients.

From the Patient Enrollment Form to the Office Staff Resource, these
downloadable and shareable resources ensure that you have the
information you need to help your patients get started on BAFIERTAM.

Patient Enrollment Form

Thumbnail of BAFIERTAM Patient Enrollment Form.

This form helps you start the process of prescribing BAFIERTAM.

DOWNLOAD ENROLLMENT FORM

Patient Consent Form

Thumbnail of Banner Patient Consent Portal.

This form allows patients to provide consent to authorize Cycle VitaTM to assist them in starting BAFIERTAM.

DOWNLOAD PATIENT CONSENT FORM

Cycle Vita Patient Support Brochure

Thumbnail of Banner Patient Consent Portal.

An overview of Cycle Vita support for BAFIERTAM patients.

DOWNLOAD BROCHURE

Patient Consideration Kit

Thumbnail of Patient Consideration Kit.

An overview of BAFIERTAM for patients considering switching or starting therapy.

DOWNLOAD PATIENT KIT
Download (Spanish Version)

BAFIERTAM Goes Direct

Thumbnail of BAFIERTAM Goes Direct Guide.

A comparative view of the disposition of fumarates and how BAFIERTAM is not like other fumarates because it goes direct.

DOWNLOAD COMPARATIVE GUIDE
Download (Spanish Version)

HCP Resource

Thumbnail of BAFIERTAM HCP Resource.

An overview of the efficacy and safety of BAFIERTAM, including patient support services available.

DOWNLOAD OVERVIEW GUIDE
Download (Spanish Version)

See the Difference

Thumbnail of BAFIERTAM See the Difference Sheet.

A summary of how BAFIERTAM differs from other oral fumarates.

DOWNLOAD DIFFERENCE SHEET

Office Staff Resource

Thumbnail of Office Staff Resource Guide.

Learn about the options available when prescribing BAFIERTAM, as well as an overview of Banner Patient Support services and financial assistance programs.

DOWNLOAD OFFICE GUIDE

Appeal Letter Template

Thumbnail of Appeal Letter Template.

An editable document that supports a medical appeal for your patient to start BAFIERTAM.

DOWNLOAD APPEAL LETTER

Letter of Medical Neccessity Template

Thumbnail of Letter of Medical Neccessity Template.

Request coverage for BAFIERTAM with an easy-to-use template that provides fields for patient information.

DOWNLOAD TEMPLATE

Specialty Pharmacy Network

Thumbnail of BAFIERTAM Specialty Pharmacy Network.

Phone, fax, and website information for the pharmacies in the BAFIERTAM specialty pharmacy network.

DOWNLOAD NETWORK INFO

Patient Information

Thumbnail of BAFIERTAM Patient Information.

Highlights and key instructions for using BAFIERTAM.

DOWNLOAD PATIENT INFO
Download (Spanish Version)

Prescribing Information

Thumbnail of BAFIERTAM Prescribing Information.

FDA-approved information on the safe and effective use of BAFIERTAM.

DOWNLOAD PRESCRIBING INFO
Download (Spanish Version)

For patients enrolled prior to April 1, 2025

We're here to help with access and reimbursement and to support your patients as they start BAFIERTAM.

Call 1-855-3BANNER
(1-855-322-6637) Monday through Friday (8:30 AM to 8:00 PM ET). También disponible en español.

For patients enrolled from April 1, 2025

A friendly, familiar team is waiting here at Cycle Vita, for you and your patients, for life.

Phone Icon 1-888-360-VITA
Phone Icon (1-888-360-8482)
Phone Icon hello@cyclevita.life
Phone Icon www.cyclevita.life

Care Manager providing BAFIERTAM access support for Multiple Sclerosis patients. Care Manager providing BAFIERTAM access support for Multiple Sclerosis patients.

Help for access and
reimbursement

GET SUPPORT

People participating in Multiple Sclerosis walk event. People participating in Multiple Sclerosis walk event.

Check out the latest
BAFIERTAM news and
events

SEE UPDATES