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Step 1Once your physician has prescribed you one of the drugs listed in the VICTORY® Program, you can enrol by phone or fax.
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Step 2You can self-enrol in the VICTORY® Program:a) By Fax
- Download the enrolment form and fill it out.
- Fax the completed form to 1‑833‑884‑5608.
- Complete the VICTORY® checklist so you can be prepared when a VICTORY® Program Reimbursement Specialist calls you within one business day of your contacting VICTORY®.
Download enrolment form here.You will need to consult your doctor to find out what type of medication has been prescribed to you before completing the form.Orb) By Phone- Complete the VICTORY® checklist.
- Call 1‑888‑706‑4717 to speak to a VICTORY® Program Reimbursement Specialist.
To prepare yourself for your call with a VICTORY® Program Reimbursement Specialist, the online checklist identifies some of the information that you will be required to provide. -
Step 3A VICTORY® Program Reimbursement Specialist will contact you within one business day and will help you navigate your coverage options with public and/or private insurance coverage.
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Step 4You fill your prescription.
Patient enrolment form
Checklist
This checklist is for personal use only and is not an online enrolment. Please call or fax to enrol.
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Access VICTORY®
Once your physician has prescribed you one
of the drugs listed in the VICTORY® Program, you can enrol in one of two easy ways:By phone:
Call a VICTORY® Program Reimbursement Specialist
at 1‑888‑706‑4717
By fax:
Download and complete the online enrolment form and fax it to
1‑833‑884‑5608