Esbriet® (pirfenidone)

Multiple Manufacturers

Send your referral electronically

You can send an electronic referral using our prescriber website Simply register or login and navigate to "Send a Referral" on the dashboard. Once logged in, you will be routed to iAssist, which is Accredo’s electronic referral service. If you are not registered for iAssist, you will be prompted to do so.

Alternatively, if you are unable to send an electronic referral, you can download the PDFs below and send to us via fax.

Referral forms for Esbriet® (pirfenidone):

Esbriet Enrollment Form

Pirfenidone Enrollment Form