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

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)

See the Difference

Thumbnail of BAFIERTAM See the Difference Sheet.

A summary of how BAFIERTAM differs from other oral fumarates.

DOWNLOAD DIFFERENCE SHEET

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

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)

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