Order Form

UPLIZNA® (inebilizumab-cdon)

UPLIZNA® (inebilizumab-cdon) is a twice-yearly treatment for neuromyelitis optica spectrum disorder (NMOSD) proven to help reduce relapses that may lead to permanent disability. The treatment is administered with 90-minute intravenous (IV) infusions twice a year (after two initial start-up doses).

For more information, please refer to the Uplizna website, medication guide, and/or prescribing information

Note: Please speak with your healthcare provider for more information if you think this therapy might be right for you.

How do I make a referral or transition my treatment to Infusion Associates?

1. Ask your healthcare provider to fax us a completed order form for your medication, clinical notes, demographics and your insurance card to (833) 996-4888.

2. Providers can find order forms on our medications page.

3. One of our intake specialists will contact your healthcare provider to confirm receipt of your referral.

4. We will then verify benefits, obtain any required prior authorizations, and contact you to schedule an appointment.