INBRIJA—for on-demand use in patients taking CD/LD
THERE ARE 2 WAYS TO PRESCRIBE INBRIJA
ePrescribe INBRIJA in 2 simple steps
Find and select Pacific LTC Pharmacy in your EMR by searching one of the options below:
NCPDP: 5664417
NPI: 1871002485
Include patient's current mobile phone number.*
Address:
351 Hospital Rd
Newport Beach, CA 92663
Chart notes and additional information
Fax chart notes or other information to (844) 317-5359
Tell your patient to expect a text† or phone call from an (844) area code within 1 to 2 hours from sending the eRx to complete enrollment and confirm next steps, including prescription fulfillment.

Complete the Prescription Request Form
FILL OUT FORM
Download and fill out a Prescription Request Form
Fax
Fax completed form to 1-855-886-2484
If you do not have access to a fax machine, call us at 1-888-887-3447.

*You may receive a phone call from an INBRIJA patient support specialist if additional information is required to initiate prior authorization.
†Standard text and data rates may apply.
EMR, electronic medical record.
INBRIJA is covered BY most
commercial plans
Our Interactive Formulary Tool can help you find out if your patients are covered
Check plans now