Not actual patients or healthcare providers.

Enroll

Getting Started with My MISSION Support

The My MISSION Support Program is designed to provide advice and support to patients and caregivers throughout the treatment journey.

Healthcare providers can request services for their eligible patients, such as:

  • Benefit Investigation and Prior Authorization Support
  • Claims and Billing Support
  • Appeals Support
  • Copay Support
  • Patient Assistance (including free drug for eligible patients through the MorphoSys Foundation Patient Assistance Program)

Have the following information ready to complete the Enrollment Form:

  • Patient Information
  • Physician Information
  • Health Insurance Information
  • HCP Authorization and Signature
  • Patient Consent and Signature

If you have any questions while completing the Enrollment Form, please call 855-421-6172, Monday to Friday, 8 AM to 8 PM ET, for personalized support from a My MISSION Support Program Specialist.

Follow these easy steps to submit your form:

Step 2: Submit Enrollment Form Via Email or Fax

To Email

Email the completed form to

access@MyMISSIONSupport.com

To Fax

Fax the completed form to 866-870-6241

Once an Enrollment Form is submitted, a My MISSION Support Program Specialist will work with you to provide patient-specific support.

My MISSION Support will reach out to the healthcare provider within 24 hours if any additional information is needed, or with directions on any next steps.