For US Health Care Professionals Only
Support for Your Patients

Novartis supports you and your patients through the EXTAVIA Go Program®

Personalized Support

The EXTAVIA Go Program® is a comprehensive collection of services focused on meeting the particular needs of you, your staff, and your patients.

The EXTAVIA Go Program offers personalized support for your staff and patients

Go Program Navigators are your single point of contact for everything from product information and questions to injection training for your patients.

Easy Enrollment

A completed, signed, and faxed service request form (SRF) serves both as a patient's first prescription for EXTAVIA and access to all that the EXTAVIA Go Program® has to offer, including:

Prescriber Support

  • Access to the Service Request Form (SRF)—one simple form to prescribe and enroll patients in the EXTAVIA Go Program®
    • Download the SRF and save a populated version
    • Sample medical necessity and claims appeals letters
  • Assistance with insurance questions

Patient Financial Assistance

  • Benefits investigation
  • Co-pay assistance
  • Referrals to other patient assistance programs

Patient Treatment Administration Assistance

  • Free injection training
  • Complimentary auto-injector to ease administration

Patient Education and Support

  • Call center clinical support
  • Patient materials for disease education and treatment management
  • Streamlined communication with specialty pharmacy to help coordinate delivery of medication and services

Get your patients started with one

simple Service Request Form (SRF)

Get your patients started with one simple Service Request Form (SRF)

For more information, visit EXTAVIA GO PROGRAM® or call 1-866-EXTAVIA (398-2842), 8 AM – 9 PM Eastern Time, Monday through Friday*

*Excludes public holidays.

For eligible patients.

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References:
1. Extavia [Prescribing Information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2016. 2. Betaseron [Prescribing Information]. Montville, NJ: Bayer HealthCare Pharmaceuticals Inc; 2016. 3. Kappos L, Polman CH, Freedman MS, et al. Treatment with interferon beta-1b delays conversion to clinically definite and McDonald MS in patients with clinically isolated syndromes. Neurology. 2006;67:1242-1249. 4. Fingertip Formulary®. Analytics report. Extavia: Percentage of covered lives. Accessed October 2017.