Resources

Patient & Physician Resources


Patient resources

Solesta Patient Informational BrochureBowel Incontinence Symptom Tracker

Physician resources

ORDERING AND BILLING

Solesta Contact Directory
Solesta Order Form (EVERSANA)
Coding and Billing Instructions for CMS Form 1500

 

 

SOLESTA REIMBURSEMENT ASSISTANCE PROGRAM (SRAP)

SRAP PROCESS OVERVIEW
SRAP PATIENT ENROLLMENT CHECKLIST
SRAP PATIENT ENROLLMENT FORM (PEF) Letter of Medical Necessity Template - Male Letter of Medical Necessity Template - Female Appeal Template - Male Appeal Template - Female

SOLESTA TEMPORARY REBATE INITIATIVE (TRI)

TRI PROCESS OVERVIEW
Solesta Rebate Request Form
Temporary Rebate Initiative Agreement

PATIENT ASSISTANCE PROGRAM (PAP)

PATIENT ASSISTANCE PROGRAM (PAP) ENROLLMENT FORM

 

GENERAL INFORMATION

Solesta Instructions for Use Solesta Pearls Presentation Solesta Pearls VIDEO with Dr. Bernstein

Additional Resources

Solesta brings you these additional resources for valuable fecal incontinence–related information to help support your patients.

The following list is not intended to be all inclusive, but it provides a representative sample of the resources available to you:

Note: These websites are neither owned nor controlled by Palette Life Sciences. Palette Life Sciences is not responsible for the content or services on these sites.