Create Practice Account
Introduction

To begin, a representative from the prescribing physician's practice must complete the practice registration process.

Before you may begin using the Provider Co-pay Portal, each user within the practice must activate his or her own account individually.

User activation does not have to be completed at the time of practice registration, but must be completed before you may begin using Provider Co-pay Portal.

You will need the following information in order to successfully register your practice:

1. User information including email address (you may add additional users at a later date)
2. Practice location information
3. Prescriber licensing information
   1. Prescriber National Provider Identifier (NPI)
   2. State License Number (optional)

You will be asked to agree to the Provider Co-pay Portal Agreement.  You must agree to these terms to proceed with Provider Co-pay Portal.