START PATIENTS WITH THE NUCALA ENROLLMENT FORM

Patient enrollment information

The enrollment form walks you through how to navigate a NUCALA prescription. It starts with your patient’s insurance coverage and the prior authorization process. Visit Gateway to NUCALA.

Download NUCALA Patient Enrollment Form (English)

Download NUCALA Patient Enrollment Form (Spanish)

NUCALA e-Enrollment form (English)

Have questions about enrolling your patients? Call 844-4-NUCALA (844-468-2252) Monday through Friday, 8 AM to 8 PM ET.

Verifying benefits

eBlu offers electronic benefit verification support for NUCALA. Visit info.eblusolutions.com/gsk or call 502-373-3258 for additional information.

Use of the eBlu platform is not a guarantee of success in obtaining third-party coverage or reimbursement. It is the healthcare provider's responsibility to provide and submit accurate and complete information to the payer. Providers should contact health plans for specific information on their coding, coverage, and payment policies.

eBlu is a registered trademark of eBlu Solutions.

Important Notice: Information regarding eBlu is brought to you as a courtesy of GSK.

Prior authorization (PA)

  • CoverMyMeds offers electronic PA forms for NUCALA. Call 1-866-452-5017 or visit CoverMyMeds.com
  • CoverMyMeds developed and maintains the website and is responsible for its content. CoverMyMeds is a registered trademark of CoverMyMeds LLC

  • Determine any PA requirements. Gateway to NUCALA can provide PA support for enrolled patients. Gateway to NUCALA cannot complete PA forms or submit related information to plans
  • Make sure you have the necessary forms from the patient’s plan
  • Follow up with the patient’s plan to determine PA submission status if requested

Appeals support

  • If PA is denied, and you feel that NUCALA is appropriate for your patient, you can consider an appeal
  • Gateway to NUCALA can help you and your patient understand the appeals process
  • See below for sample letters of appeal and medical necessity 

Sample Letter of Appeal

Sample Letter of Medical Necessity

Alternative site of care

If your patient’s place of administration differs from the prescribing office:

Consult your patient’s insurance or contact Gateway to NUCALA to identify an appropriate site of care (infusion center). Work with the site of care to determine responsibility for benefits investigation and prior authorization.

Additional questions?

Have other questions about starting your patients on NUCALA?

Call 844-4-NUCALA (844-468-2252) Monday through Friday, 8 AM to 8 PM ET.

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Get support for patients on their NUCALA treatment journey

Enroll your patients today to unlock support for NUCALA:

  • Savings & access options for eligible patients
  • 1-on-1 support team assistance
  • Relevant tools and resources as they start NUCALA treatment

ENROLL NUCALA PATIENTS NOW