Samples & patient savings

IBSA Pharma is committed to supporting healthcare professionals in their mission to treat patients. IBSA offers the following support material to medical professionals and their staffs:

Product samples

To order samples of Tirosint, click the link below and follow the directions. Please note that any Sample Request Forms must be signed by a healthcare professional who is licensed to prescribe medication in the United States. In most cases, samples will be shipped within 3 business days after receipt of a fully completed Sample Request Form. There is a limit of one sample shipment per month, per licensed prescriber.

Click here for a Tirosint Sample Request Form.

Patient information and copay savings

A variety of Tirosint patient support material is available for your practice including:

  • Patient brochure explaining hypothyroidism and Tirosint
  • Administration instructions
  • Copay Savings Card

You will automatically receive a quantity of patient support material when you order Tirosint samples. If you are only interested in receiving patient support material, please contact us at medinfo@ibsapharma.com.

Request a IBSA Sales Representative

You can request a Tirosint sales representative at medinfo@ibsapharma.com.

Prescribing via Tirosint Direct Program

The Tirosint Direct Program provides your patients with the opportunity to purchase their Tirosint therapy at the lowest cash price available. The ordering process is fast and easy. You can send your prescriptions to one of the Tirosint Direct participating mail order pharmacies either by e-prescribing or by fax.

Who can benefit from the Tirosint Direct Program?

Any patient who wants to save money on their Tirosint prescription can benefit from the Tirosint Direct Program. Patients without commercial insurance, those with high copays or deductibles, or who are paying cash for their prescriptions (including Medicare Part D patients paying cash) can purchase Tirosint at a significant discount compared to traditional retail pharmacies. Even patients with commercial health insurance can benefit from the program as their prescriptions can be dispensed using their insurance program or paid for with cash. In either case, customer service agents will advise patients as to which option will provide them with the lowest out-of-pocket cost for their prescription.

Advantages of the Tirosint Direct Program for your practice

The Tirosint Direct Program can save time for you and your office staff. Mail order pharmacies participating in the program offer the following services:

  • Insurance verification and Prior Authorization Assistance
  • Fast and accurate door-to-door delivery
  • Refill reminders for patients
Highland Logo

To send a prescription electronically, use one of the following codes: NABP is 2588842 OR 601.268.6033 OR Highland Specialty – Hattie

Delta Logo

To add Delta Drugs Pharmacy to your EMR system, use the following information:
a. Delta Drugs Pharmacy 437 Fernando Ct Glendale, CA 91204 OR
b. NPI: 1790036671
Please write in the Notes section: Ok to do PA
Add patient social security number on the e-script.

TPS - Transition Pharmacy logo

To send a prescription electronically, use one of the following codes: NCPDP: 3989603 OR NPI: 1336325265 (City: Feasterville-Trevose, Zip 1

Sterling Specialty Pharmacy logo

Medical information

For medical information please call 800-587-3513 or email medinfo@ibsapharma.com.

Click here for an IBSA Pharma Medical Information Request Form.

To Report Adverse Events

To report an adverse event or product quality complaint please call 800-587-3513 or email medinfo@ibsapharma.com.

Patient Assistance Program (PAP)

IBSA offers a patient assistance program providing IBSA brand name medications to individuals who meet eligibility requirements. Eligibility is based on your annual household income and prescription insurance status. To see if you are eligible, complete and return the enrollment form. If you qualify, you will automatically be mailed your first 30-day supply. You will then be eligible to receive free medicine(s) for up to one year by calling to refill your prescription every month. You must re-enroll each year to remain in the program.

For more information on eligibility and how to enroll, visit www.ibsapap.com.

Language to Prevent Generic Substitution

Only prescriptions for branded Tirosint capsules are eligible for Tirosint patient savings programs. Make sure that your patients get branded Tirosint capsules by specifying “DAW” or your state’s equivalent terminology on all of your Tirosint prescriptions. To see the exact terminology required in your state, click on the appropriate selection below.

Sign the prescription signature line labeled “Dispense as Written”

Write “Brand Medically Necessary” or similar words

Expressly indicate that substitution is not allowed. For example, write “Dispense as Written” or words of similar language

Expressly indicate that substitution is not allowed. For example, write “Dispense as Written” or words of similar language

Write the words “Do Not Substitute” or words of similar meaning, or initial box labeled “Do Not Substitute”

Write the words “Do Not Substitute” or “Dispense as Written” or initial the “Do Not Substitute” or “Dispense as Written” box

Write the words “Brand Medically Necessary” or “No Substitution” on the appropriate line

Write the words “Brand Necessary” or “Brand Medically Necessary”

Write “Medically Necessary” or, with an electronically generated and transmitted prescription, make an overt act that brand is medically necessary

Write the words “Brand Necessary” or “Brand Medically Necessary”

Write the words “Brand Necessary” or “Brand Medically Necessary”

Indicate by any means that a brand name drug must be dispensed (e.g. write “Brand Necessary”)

Indicate “May Not Substitute”

Sign the prescription signature line labeled “Dispense as Written” and write “Brand Medically Necessary”

Expressly indicate that no substitution is allowed. For example, write “Dispense as Written” or words of similar language

Expressly indicate that no substitution is allowed (for example, indicate “Dispense as Written”) and sign the prescription signature line labeled “Dispense as Written”

Write “Do Not Substitute,” “DNS,” or any phrase generally known throughout the medical and pharmaceutical professions as meaning the same thing; on a preprinted form, check the appropriate box meaning “Do Not Substitute”

Indicate “Dispense as Written” or “DAW”; for a Medicaid prescription, handwrite the words “Brand Necessary” or “Brand Medically Necessary” on the face of the prescription or on a sheet attached to the prescription

Write the words “Dispense as Written”, “DAW”, “Brand”, “Brand Necessary” or “Brand Medically Necessary”; if there is a check box on the prescription, check it

Expressly indicate that substitution is not allowed. For example, write “Brand Medically Necessary” or words of similar language

Write the words “No Substitution”

Write the words “Dispense as Written” or “DAW”

Write the words “Dispense as Written” or “DAW”

Sign the prescription signature line labeled “Dispense as Written”

Sign the prescription signature line labeled “Dispense as Written”

Write “Brand Medically Necessary”

Write the words “No Drug Product Selection,” “Dispense As Written,” “Brand Medically Necessary,” or “No Generic Substitution,” or “N.D.P.S.,” “D.A.W.,” or “B.M.N.”

Write the words “Dispense as Written”

Write the words “Medically Necessary”

Initial the prescription blank next to “Do Not Substitute”

Write the words “No Substitution” or “No Sub”

Write the initials “DAW” in the appropriate box

Write the initials “DAW” in the appropriate box

Write the words “Brand Medically Necessary”

Write the words “Dispense as Written”or “DAW”

Substitution is prohibited unless authorized by the prescriber or patient

Write the words “No Substitution” or words of similar meaning

Write the words “Brand Necessary” or “Brand Medically Necessary”

Write the words “Brand Necessary” or “Brand Medically Necessary”

Sign the prescription signature line labeled “Dispense as Written”

Write the words “Brand Necessary” or words of similar meaning

Write the words “Brand Medically Necessary”, “Dispense as Written”, “Medically Necessary”, “No Generic”, or words of similar meaning

Write the words “Brand Necessary” or “Brand Medically Necessary”

Write the words “Dispense as Written” or check the “Dispense as Written” box on a preprinted form

Write the words “Brand Necessary”, “No Substitution”, “Dispense as Written”, or “DAW”

Write the words “Brand Medically Necessary”

Sign the prescription signature line labeled “Dispense as Written”

Write the words “Dispense as Written”, “D.A.W.” or words of similar meaning

Write the words “Brand Medically Necessary”

Write the words “No Substitution” or “N.S.” or words of similar meaning

Expressly indicate that substitution is not allowed. For example, indicate the words “Dispense as Written” or words of similar language