DAYBUE PRESCRIPTION AND ENROLLMENT FORM

Form used to prescribe DAYBUE to your patients and enroll them in Acadia Connect (with consent from the parent/legal guardian).

DAYBUE ANNOTATED PRESCRIPTION AND ENROLLMENT FORM

A helpful guide with instructions for completing the DAYBUE Prescription and Enrollment Form.

HOW TO PRESCRIBE DAYBUE™ (trofinetide) WITH THE SUPPORT OF ACADIA CONNECT^®

A guide to help set expectations for you and your practice when prescribing DAYBUE, and highlights support available from Acadia Connect.

DAYBUE PRIOR AUTHORIZATION CHECKLIST

A checklist to help ensure you and your practice understand potential prior authorization criteria to help prevent rejections and unnecessary delays.

DAYBUE CODING AND PRODUCT FACT SHEET

Coding and product information that may be helpful when prescribing DAYBUE and seeking coverage for your patients.

SAMPLE LETTER OF MEDICAL NECESSITY

A letter template to help support your clinical rationale for treatment.

ACADIA CONNECT OVERVIEW

An overview of Acadia Connect, including support offerings and resources.

SAMPLE LETTER OF APPEAL

A letter template requesting a reversal of the health plan’s coverage denial for DAYBUE.

SAMPLE VOICE OF THE PATIENT LETTER OF APPEAL

A letter template for your patient’s caregiver to request a reversal of the health plan’s coverage denial for DAYBUE.

SAMPLE REAUTHORIZATION LETTER OF APPEAL

A letter template to appeal a reauthorization denial for your patients who already received treatment.

DAYBUE ACCESS PROCESS GUIDE

A guide with information on accessing DAYBUE and receiving coverage support (eg, help with prior authorizations and appeals) through Acadia Connect.