Maxor Specialty Forms
On this page, you’ll find important forms and documents you may need as you work with Maxor Specialty. If you do not see a form you need, please contact Maxor Specialty at 1 (866) 629-6779.
Patients
- Cayston Patient Authorization Form
- VALTOCO Instructions for Use – 5mg and 10mg
- VALTOCO Instructions for Use – 15mg and 20mg
- VALTOCO Patient Tip Sheet
Providers
- Adbry Advocate Enrollment Form
- Arikayce Enrollment Form
- Bronchitol Service Request Form
- Cayston Access Program Enrollment Form
- Cystic Fibrosis Enrollment Form
- Fensolvi Enrollment Form
- Hemangeol Prescription Form
- Vertex GPS Enrollment Form
Infusion
Refill your
prescriptions.
Patient Information
Welcome Packet Documents – Spanish
Questions?
Contact Maxor Specialty anytime.
P: 1 (866) 629-6779
Pharmacy Benefit Management
Expires 01/01/2024
Mail Service Pharmacy
Expires 06/01/2023