By registering your treatment site on TEZSPIRE Locator, you are acknowledging that TEZSPIRE (tezepelumab-ekko) can be billed through your patient's Medical Benefit for Medicare Part B and commercial insurance plans.

By clicking "I Agree/Submit" below, the entity named above agrees as follows:

Terms and Conditions:

In order to participate in the treatment site locator of TEZSPIRE Locator, sites must be willing to accept faxed medical orders and insurance coverage information, accept a call from a patient making an injection appointment, purchase and administer TEZSPIRE, and bill the appropriate insurance company through the patient's medical benefit for Medicare Part B and commercial insurance plans. Entities that enroll in the TEZSPIRE Locator treatment site locator must not be listed on any federal exclusion or debarment lists (such as the OIG's List of Excluded Individuals/and Entities on the Excluded Parties List). Choices provided are based on proximity to the patient/provider requesting assistance and/or criteria provided by the requesting provider/patient.

Participation Authorization:

The entity named above understands the terms and conditions above for listing the treatment site in the TEZSPIRE Locator, and that those terms and conditions are subject to change without notice. The entity named above certifies that it has the appropriate licensure to carry out these services as required by applicable state laws. By providing the requested information, the entity named above represents and warrants that it is authorized to disclose such information to a third party such as Amgen and AstraZeneca. The entity named also represents and warrants that the information submitted in the registration form is accurate and up to date.

Listing a treatment site in the TEZSPIRELocator is not a guarantee that any particular healthcare professional or patient will choose the treatment site. It is understood that listing a treatment site in the TEZSPIRE Locator is not a guarantee of business and that Amgen and AstraZeneca are not providing referrals. In the event a treatment site is chosen through the TEZSPIRE Locator, it is the duty of each provider, patient, and treatment site to understand payer-specific policies. Prior authorization may be required. Amgen and AstraZeneca assume no liability for patient payment or care.

The entity named above agrees to be listed in the TEZSPIRE Locator and to receive communication related to TEZSPIRE Locator and similar Amgen and AstraZeneca services.

Both Amgen and AstraZeneca and the entity named above reserve the right to end this agreement with 30 days advance notice to ensure patient treatment is not disrupted. If there is "cause," then agreement may be terminated immediately.

By submitting this form, I verify that I am an employee or agent of the site listed above and I am authorized to add, edit, or delete this account profile.