Once you write a prescription for your patient, make sure they fill out this form to give your team permission to share their medical information with NS Support.
All sections need to be filled out in their entirety.
3
Mail or fax us the completed form
By Mail: NS Support Co-pay Assistance Program
PO Box 7613, Overland Park, KS 66207-9941
By Fax: 888-212-0482
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