Mulpleta Assist Helps Make Mulpleta Easy to Access

Mulpleta Assist helps to ensure that patients will receive Mulpleta before their procedure

3 Easy Steps to Prescribe Mulpleta

Schedule procedure

Schedule your patient's procedure

Determine start date for Mulpleta

Determine the start date for Mulpleta (8-14 days before procedure)

Complete enrollment form and send to Mulpleta Assist

Complete the Mulpleta Prescription Enrollment Form and send to Mulpleta Assist

Name: Mary Smith*
Procedure: Colonoscopy with polypectomy

Get Mary Started on Mulpleta

Procedure scheduled for the 28th

Start Mulpleta on the 18th (10 days before procedure)

Upon receipt of the completed Mulpleta Prescription Enrollment Form, Mulpleta Assist will review Mary’s benefits and arrange delivery of Mulpleta

*Not an actual patient.

Enroll Patients in Mulpleta Assist

Fax Enrollment

Download the printable Mulpleta Prescription Enrollment Form and fax the completed form to Mulpleta Assist (1-866-204-9252)

Online Enrollment

Enroll patients through the Mulpleta Assist online portal at

Through Mulpleta Assist, a dedicated support team provides:


Logistics Management

  • Benefits investigation and prior authorization support
  • Collaboration with specialty pharmacy
  • Updates for healthcare providers and patients throughout the process
Financial assistance

Financial Assistance

  • Copay assistance for eligible commercially insured patients
  • Patient assistance for eligible uninsured or underinsured patients


Personalized Support

  • Shipment of Mulpleta directly to the patient's home or healthcare provider’s office
  • On-time delivery before the procedure
  • Calls to remind patients when to start taking Mulpleta


Download materials for your
practice and patients.