PATIENT CONSENT
COMING SOON
PATIENT CONSENT
PROVIDER PORTAL
COMING SOON
PROVIDER PORTAL

Celltrion CONNECT® Patient Support Program offers comprehensive services to patients prescribed ZYMFENTRA™ (infliximab‑dyyb).

Start with confidence by enrolling in Celltrion CONNECT Patient Support Program for ZYMFENTRA. Once enrolled, a Celltrion CONNECT Case Coordinator will:

Verify insurance coverage for both ZYMFENTRA and intravenous (IV) infliximab

Assist with prior authorization and appeals

For patients experiencing a delay in coverage from their commercial insurance, Celltrion may be able to help. Enroll in Celltrion CONNECT or call 1-877-81CONNECT (1-877-812-6662), Monday – Friday between 8 AM – 8 PM ET.
  • Attach both sides of the patient’s insurance card(s)
  • Attach the patient’s demographics, chart notes, and clinical documentation
  • Have the patient and prescriber sign the form
  • Fax the completed form to 833‑912‑3707
1
OR
HCP portal [coming soon]

Instruct the patient to assess and sign patient consent here

2
OR
Send an ePrescription
  • Select ePrescribe to Phyz via the pharmacy drop-down menu:

NCPHP: 5928809
Phone: 844-590-5792

  • Phyz will facilitate the enrollment process with Celltrion CONNECT
  • Attach the patient’s insurance card(s), demographics, chart notes, and clinical documentation
  • Celltrion CONNECT will forward the ZYMFENTRA prescription to the patient’s pharmacy of choice
3
  • Attach both sides of the patient’s insurance card(s)
  • Attach the patient’s demographics, chart notes, and clinical documentation
  • Have the patient and prescriber sign the form
  • Fax the completed form to 833‑912‑3707
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