CONTACT US: Monday through Friday, 8 AM-8 PM ET. Phone: 1-844-523-6661 1-844-523-6661 Fax: 1-833-635-1481 1-833-635-1481

RESOURCES

Find helpful resources for you and your patients.

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MyROCK ASSIST enrollment form

Our online enrollment form makes enrolling your patients in MyROCK ASSIST simple and straightforward.

ENROLL YOUR PATIENTS ONLINE NOW

If you prefer, download a paper enrollment form, work with your patients to complete the form and fax it to 1-833-635-1481 to begin the MyROCK ASSIST enrollment process.

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Letter of medical necessity

This template may be used to verify the patient’s need for medical treatment with REZUROCK® (belumosudil) tablets.

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Letter of appeal

If a patient’s health insurance plan denies their request for prior authorization or coverage for REZUROCK® (belumosudil) tablets, this templated letter may help with the appeal process.

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REZUROCK ordering form

Find out how to order REZUROCK for your account.

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MyROCK ASSIST brochure

A guide to financial assistance and support for patients on REZUROCK.

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PROGRAM ENROLLMENT FORM

Find out which services patients may be eligible for by completing this form. Our MyROCK ASSIST Case Managers can determine which programs are available to patients.

ENROLL ONLINE
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ENROLL FOR CO-PAY SUPPORT

For eligible patients with commercial or private insurance plans.

ENROLL ONLINE
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CONTACT US

Our MyROCK ASSIST team is available to help you Monday through Friday, 8 AM-8 PM ET.
Phone: 1-844-523-6661 1-844-523-6661
Fax: 1-833-635-1481 1-833-635-1481