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All rights reserved. NORTHERA is a trademark of Lundbeck NA Ltd. DRX-B-00023a 4 03/2015 www. NORTHERA. Form from www. needymeds. org GETTING YOUR PATIENT STARTED WITH NORTHERA droxidopa NORTHERA is only available via Specialty Pharmacy and by using the enclosed NORTHERA Treatment and Prescription Forms. Com Reset Form NORTHERA droxidopa TREATMENT FORM Please complete this form in its entirety and fax to the NORTHERA Support Center at 844-601-0102. The Specialty Pharmacy may contact your...
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