Forms & Documents
- XOSPATA Support SolutionsSM Patient Enrollment Form
(PDF - 207 KB) - Sample Letter of Medical Necessity
(PDF - 88 KB) - Sample Letter of Denial Appeal
(PDF - 84 KB) - Patient Authorization Form
(PDF - 280 KB)
To access insurance-related forms (including prior authorization forms) for Astellas products, please click here.
If you do not see a form that you need, please call us at 1-844-632-9272. We are available Monday–Friday, 8:30 am–8:00 pm ET.