Bylvay enrollment forms
Complete and submit the forms to Optum Frontier Therapies.
Sending your prescription
To submit a Bylvay prescription, the prescribing provider will need to complete a therapy enrollment form and also supply a patient consent form below.
- When filling out the therapy enrollment form, be sure to note Optum Frontier Therapies as your preferred pharmacy.
- Once the prescribing provider and the patient complete and sign these two forms, the prescription is ready to submit.
Find more information on the three ways to send us a prescription here.