Uplizna

(inebilizumab)
UPLIZNA 3 Vial KitUPLIZNA 100 MG in10 ML Injection
NO BLACK BOX WARNING

Dosage & administration


drug label

Uplizna prescribing information

prior authorization

Uplizna prior authorization resources

Most recent Uplizna prior authorization forms

View By Payer
Updated: May 31, 2023Cigna - Uplinza Prior Authorization Form
Updated: May 29, 2023Blue Cross Blue Shield of Michigan - Uplinza Prior Authorization Form (Medical Benefit)
Updated: May 24, 2023Aetna - Medicare Part B Uplinza Prior Authorization Form
Updated: May 24, 2023Aetna - Uplinza Prior Authorization Form

OTHER
Complete Letter of Medical Necessity

OTHER
Coverage Authorization Appeals

PDF
PA Considerations

PDF
PA Checklist

PDF
Appeals Checklist
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Benefits investigation

PDF
Uplinza Patient Enrollment Form
Uplinza Patient Enrollment Form - Online
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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information
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pharmacy

Uplizna preferred pharmacy

PDF
Pharmacy List

financial assistance

Uplizna financial assistance options

Co-pay savings program

commercial only

PDF
Uplinza Patient Enrollment Form
Uplinza Patient Enrollment Form - Online

OTHER
Enroll in Patient Savings Program
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Bridge program

commercial only

PDF
Uplinza Patient Enrollment Form
Uplinza Patient Enrollment Form - Online

PDF
Starter Bridge Program
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patient education

Uplizna patient education

Getting started on Uplizna

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

BRAND PAGE
About Uplinza
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Receiving Uplinza
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

VIDEO
Patient Stories
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

PDF
Patient Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

OTHER
Doctor Discussion Guide
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
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Other resources

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people also ask

Uplizna FAQs

How is the dosage of Uplizna?Uplizna is available in 2 dosages, including 10 mg/ml Injection 10 ml and mixed Pack
What does Uplizna treat?Uplizna treats Neuromyelitis Optica
How Is Uplizna Administered?Uplizna is administered as a Injectable or Pack
FAQ Data Source