Forms and resources
Find informative resources, guides, and forms below to help your patients get started on AkebiaCares, access their Akebia medication, and navigate Medicare.
Enrollment
AkebiaCares enrollment form
Complete an enrollment form online or download the form and fax it to once completed.
Download form AkebiaCares enrollment form tips
Helpful tips to consider when filling out the AkebiaCares enrollment form.
Download PDF Patient consent form
This form can be used to capture patient consent if a patient is not present to sign consent on an AkebiaCares enrollment form.
Understanding AkebiaCares
Download this brochure to learn more about AkebiaCares and how the program is designed to support your patients.
AkebiaCares re‑enrollment form
Complete a re‑enrollment form online or download the form and fax it to once completed to keep your patient enrolled in AkebiaCares.
Download form Resources to help access medication
Pharmacy options and locator
Find pharmacies that best fit your patients' needs and get connected to a specialty pharmacy locator.
Download PDF How to refer an Rx
Get information on how to submit a prescription to a specialty pharmacy.
Download PDF Help for patients with Medicare
Medicare brochure
For patients and caregivers who have questions about Medicare, this brochure can help them better understand the government program, eligibility requirements, coverage costs and rules, and how to qualify for Extra Help.
Patients with government insurance may be able to receive financial assistance from independent third-party foundations, such as:
Prior Authorization, Medical Exception, and Appeal guidelines
Considerations for submitting a Prior Authorization (PA)
What to know when submitting a PA.
Download PDF Considerations for composing an Appeal Letter
Helpful information to write and submit an Appeal Letter.
Download PDF Considerations for submitting a Medical Exception form
Get information to successfully submit a complete Medical Exception request form.
Download PDF Assistance with PAs
CoverMyMeds automates the PA process to make completing, reviewing, and tracking PA requests quicker and easier, helping patients get their prescribed medication sooner.
