Specialty Drug Forms
Get started with RightSourceRx Specialty by downloading and printing the forms below.
Physician Fax Forms
Ask your doctor to fill out and fax your new prescription with the drug-specific fax form to us at 1-877-405-7940. RightSourceRx Specialty will only accept faxes from providers.
- Amevive (alefacept)
- (252 KB) Download PDF
- English
- Avonex
- (252 KB) Download PDF
- English
- Betaseron
- (252 KB) Download PDF
- English
- Cimzia (certolizumab)
- (252 KB) Download PDF
- English
- Copaxone
- (252 KB) Download PDF
- English
- Enbrel (etanercept)
- (252 KB) Download PDF
- English
- Genotropin
- (252 KB) Download PDF
- English
- Gleevec (imatinib)
- (252 KB) Download PDF
- English
- Humatrope
- (252 KB) Download PDF
- English
- Humira (adalimumab)
- (252 KB) Download PDF
- English
- Infergen (interferon alfacon_1)
- (252 KB) Download PDF
- English
- Intron-A (interferon alfa-2b)
- (252 KB) Download PDF
- English
- Kineret (anakinra)
- (252 KB) Download PDF
- English
- Norditropin
- (252 KB) Download PDF
- English
- Nutropin
- (252 KB) Download PDF
- English
- Omnitrope
- (252 KB) Download PDF
- English
- Orencia (abatacept)
- (252 KB) Download PDF
- English
- Pegasys (peginterferon alfa 2b)
- (252 KB) Download PDF
- English
- Peg-Intron (peginterferon alfa-2b)
- (252 KB) Download PDF
- English
- Rebif
- (252 KB) Download PDF
- English
- Remicade
- (252 KB) Download PDF
- English
- Ribavirin products
- (252 KB) Download PDF
- English
- Saizen
- (252 KB) Download PDF
- English
- Serostim
- (252 KB) Download PDF
- English
- Sprycel (dasatinib)
- (252 KB) Download PDF
- English
- Targretin (bexarotene)
- (252 KB) Download PDF
- English
- Tev-Tropin
- (252 KB) Download PDF
- English
- Thalomid (thalidomide)
- (252 KB) Download PDF
- English
- Tysabri (natalizumab)
- (252 KB) Download PDF
- English
- Zorbitive
- (252 KB) Download PDF
- English
