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.

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Enrollment

AkebiaCares enrollment form

Complete an enrollment form online or download the form and fax it to 866‑310‑7424  once completed.

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AkebiaCares enrollment form tips

Helpful tips to consider when filling out the AkebiaCares enrollment form.

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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 866‑310‑7424  once completed to keep your patient enrolled in AkebiaCares.

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Resources to help access medication

Affordability flashcard

Discover available resources for every type of insurance.

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Pharmacy options and locator

Find pharmacies that best fit your patients' needs and get connected to a specialty pharmacy locator.

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How to refer an Rx

Get information on how to submit a prescription to a specialty pharmacy.

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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.

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Considerations for composing an Appeal Letter

Helpful information to write and submit an Appeal Letter.

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Considerations for submitting a Medical Exception form

Get information to successfully submit a complete Medical Exception request form.

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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.

Next page: Frequently asked questions