1. Download the enrollment form
Download and print the Takeda Oncology Here2Assist enrollment form. It is available in both English and Spanish.
2. Complete with your patient and sign
Work together with your patient to fill out the enrollment form. Ensure that the form is fully completed and includes your signature before you submit it.
3. Fax
Fax the completed enrollment form along with a copy of your patient’s insurance card and prescription to 1‑844‑269‑3038.
Can my patient enroll online?
Yes, your patient has the option to enroll online by visiting Here2Assist.com/enroll and completing the following steps:
- Your patient initiates enrollment by filling out their form
- We notify you when they are done and request your review and signature
- You will need to complete and submit the form via fax or email
Reach out to a case manager if you need assistance with a patient-initiated enrollment. Call us at 1-844-817-6468, Option 2. We’re available Monday-Friday, 8AM-8PM ET.
Once fully enrolled, you and your patient can expect:
A welcome call from a case manager
A case manager will call your patient to welcome them to the Takeda Oncology Here2Assist Program. Your patient will then receive an email asking them to join the patient portal, myHere2Assist™.
myHere2Assist allows patients to:
- Monitor the status of their benefits investigation
- View their prescription status
- Access resources that support their treatment journey
An efficient benefits investigation and verification review
A case manager will work to complete a timely benefits investigation and communicate a summary of coverage to both you and your patient.
Understand Your Patient's Coverage
Help with addressing potential delays in treatment
If your patient’s insurance provider does not complete their determination of coverage within 5 business days, your patient may be eligible to receive their first month of Takeda Oncology medication at no cost through the RapidStart Program.
RapidStart Program
In such cases, you can work with your patient to complete a RapidStart request form. Please note that your patient must be enrolled in Takeda Oncology Here2Assist to be considered. Terms and conditions apply.*
Identification of financial assistance programs
Based on your patient's insurance coverage, a case manager can provide information on available support through the Takeda Oncology Co-Pay Assistance Program or the Takeda Oncology Patient Assistance Program.
Explore Financial Assistance
Reliable product distribution and prescription fulfillment
Takeda Oncology Here2Assist works with your office to help identify specialty pharmacies or in-office dispensing options for fulfilling your patient’s prescription by connecting you with the specialty distributor for their specific treatment.
Review Fulfillment Options
Ongoing support and education
A case manager will conduct follow-up calls with your patient on a regular basis and provide continuous support by offering:
- Nurse navigators to support product education*
- Access to the myHere2Assist patient portal
- Status updates via text message†
Have your patient visit Here2Assist.com/patient to find more resources.
*For FRUZAQLA™ (fruquintinib) and ICLUSIG® (ponatinib) patients only.
†Patients will need to enroll in the texting program to receive text messages.