Doptelet Access and Enrollment Forms

Explore all the ways your adult patients with chronic immune thrombocytopenia can gain access to Doptelet.

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Doptelet Access and Support Resource Guide

Offers a collection of digital resources for HCP office staff to navigate Doptelet access and reimbursement process.

Patient Support and Financial Assistance 

Enrollment Guide

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Getting Started with Doptelet

Gives an overview of the Doptelet access process and the pathway options from prescription through continuing care.

Accessing Doptelet Documents

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Doptelet Prior Authorization Resource Guide

Explains general steps in the prior authorization process to help HCP offices get patients started on Doptelet.

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Accessing Doptelet: Specialty Pharmacies and Distributors

Lists the contact information for the specialty pharmacies and distributors that are authorized to dispense Doptelet.

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Coding Resource

Provides useful codes to identify appropriate patients and assists with the billing and reimbursement of Doptelet.

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You’ve Prescribed Doptelet: Now What?

Outlines the process for patients in obtaining a Doptelet prescription with a specialty pharmacy.

See Formulary Status in Your Area

Formulary coverage of Doptelet on selected plans in:

Do you have questions on getting access to therapy for your patients related to COVERAGE, PRIOR AUTHORIZATION, or STEP EDITS?
Consult with your dedicated field reimbursement senior manager at

Please include the following information with each email inquiry:
1) Practice Name 2) Contact Name 3) Direct Phone Number 4) State and ZIP Code 5) Issue Needing Assistance

For Pharmacies and Distributors

Doptelet prescriptions are filled only through specialty pharmacies in the Doptelet network or by dispensing physician practices. Specialty pharmacies typically mail the patient prescriptions directly to the patient. There are also physician practices that elect to dispense Doptelet through their in-office dispensing pharmacies.

Doptelet Financial Assistance

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Doptelet Connect provides information regarding patient healthcare coverage options and financial assistance information that may be available to help patients with financial needs.*

For more information, call 1-833-368-2663. Monday-Friday 8 AM-8 PM ET.


Doptelet Connect Can Help Your Patients

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Patient Enrollment Process

To enroll a patient, complete the form, including all healthcare provider and patient signatures and fax to 855-686-8729.

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Patient Consent Form

Authorization provides patient/caregiver access to the Doptelet Connect Patient Support Program.
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Explains relationship between the HCP offices and Doptelet Connect and steps each may take during the access process.

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Doptelet Patient Assistance Program

Provide Doptelet at no cost to patients who meet the eligibility requirements.
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Enrolling Your Patients

After a patient has been prescribed Doptelet, the patient can be enrolled in Doptelet Connect. To enroll a patient, complete the Prescription and Enrollment Form below, including all healthcare provider and patient signatures, and fax to 855-686-8729.

*In order to participate in the Doptelet Copay Assistance Program (“Program”), a patient must be aged ≥18 years and have commercial prescription insurance for Doptelet. This Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including (but not limited to) Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. This offer is not valid for patients paying with cash. The Program is void where prohibited by law. Certain rules and restrictions apply. Sobi reserves the right to revoke, rescind, or amend this offer without notice. This Program is not insurance.

Program subject to eligibility requirements and program terms and conditions.

Act Now: Doptelet Connect

Doptelet Copay Assistance Program

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Doptelet Connect