Submitting a prescription to ARESTIN Rx Access is easy 

Step 1:
Start a prescription online,* by phone, or by fax.

Before beginning a submission, make sure you have your patient's insurance card ready.

Online*

Log in to the ARESTIN Rx Access Portal to print a pre-filled Prescription Form and download a Copay Assistance Patient Eligibility Form.

Phone

Call the dedicated service center: 1-855-684-7481, 8 am-8 pm ET, Monday-Friday and a pre-filled Prescription Form and a Copay Assistance Patient Eligibility Form will be faxed to you.


Step 2:
Complete and sign both the Prescription Form and the Copay Assistance Patient Eligibility Form and fax the signed forms to 1-855-630-9783.

Don’t forget, the Prescription Form requires a dentist’s signature, and the Copay Assistance Patient Eligibility Form requires a patient’s signature.

WATCH THIS VIDEO

to learn how to submit a prescription to ARESTIN Rx Access

WATCH THIS VIDEO

to learn the simple steps of the prior authorization process.

*Login required. Visit RxAccessPortal.com to create an account for the ARESTIN Rx Access Online Portal.