Prior Authorization of Dupixent (dupilumab) – Pharmacy Services BY Sally A. or U. Pricing Principles;. This information will ONLY be used to validate your eligibility. DUPIXENT MyWay is a patient support program that can help enable access to DUPIXENT and offers financial assistance for eligible patients, one-on-one nursing support, and more. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. g. Since Dupixent can be quite expensive, reimbursement programs help to mitigate the cost for eligible patients. Also, some companies require that you have no insurance. Kozak, Deputy Secretary Office of Medical Assistance Programs IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every 5 years. Patients will need to meet the eligibility criteria, including household income, to qualify. I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Do not heat the syringe. I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Simplefill helps Americans who are struggling. The guidelines to determine the medical necessity of Dupixent (dupilumab) will be utilized in the fee-for-service and managed care delivery systems. 30 Section: Prescription Drugs Effective Date: April 1, 2021 Subsection: Topical Products Original Policy Date: April 7, 2017 Subject: Dupixent Page: 4 of 10 AND submission of medical records (e. The insurance companies do this by looking at where the money to pay a copay is coming from. COSENTYX ® Connect is a personalized support program for people taking or considering COSENTYX ® (secukinumab). 2 pens of 300mg/2ml. I have private insurance which helps with some of the cost, after the co-pay assistance through Sanofi. The General Assistance (GA) program (PDF) helps people without children pay for basic needs. Paller AS, Simpson EL, Siegfried EC, et al. For treatment of chronic rhinosinusitis with nasal polyposis: Will use Dupixent as an add-on maintenance treatment for inadequately controlled chronic rhinosinusitis with nasal polyposis 4. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. If you need help paying for your prescription, the DUPIXENT MyWay Patient Assistance Program may be able to help. Eligible patients will receive their cards by email. Dupixent is one shot self administered every two weeks, and delivered to my door through the specialty Pharm. There is currently no generic alternative to Dupixent. to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1,. ca. Manufacturer copay cards are a way to save on medications. If you still have questions, you can speak with a DUPIXENT MyWay representative or request to join the program over the phone. Enroll now to receive emails and resources designed to help patients, caregivers and information seekers through the DUPIXENT® (dupilumab) treatment journey. I have definitely heard that before from multiple sources. facilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. g. , One-on-One Nurse Education, and Supplemental Injection Training) Please click “Continue. Sign up to connect with a DUPIXENT MyWay® mentor to help patients with Nasal Polyps through their DUPIXENT. I certify that I have obtained my patient’s written authorization in accordance with applicable DUPIXENT® (dupilumab) therapy (“My Information”). The DUPIXENT MyWay team can research each patient’s situation and determine eligibility. g. Only a doctor or nurse practitioner can apply for coverage through the Exceptional Access Program. Here’s an NBC News article about it. g. Dupixent MyWay Enrollment Form: Asthma 10/10/23 Dupixent. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the type 2 inflammation that plays a major role in multiple related and often co-morbid diseases. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central. Data from DUPIXENT ® clinical trials have shown that IL-4 and IL-13 are key drivers of the type 2 inflammation that plays a major role in asthma, atopic. g. Need additional guidance with the enrollment process? Call DUPIXENT MyWay at 1-844-387-4936 Monday through Friday, 8 am to 9 pm Eastern Time. DUPIXENT MyWay is a patient support program that can help enable access to DUPIXENT and offers financial assistance for eligible patients, one-on-one nursing support, and more. This copay card may be for you if you. They help people afford expensive prescription medications by lowering their out-of-pocket costs. Copay amounts after applying copay assistance may depend on the patient’s insurance. 3 MB) Application Instructions For New Patients: Apply online through the Patient Assistance Now Oncology (PANO) program 1 800 282 7630 Patient portal |. DUPIXENT: your first choice to adequately control this chronic, systemic disease. Patient Savings Center - beta. Through the program, people can receive up to $1,500 in financial assistance to help pay for Dupixent, access to a dedicated team of nurses, access to free medical supplies, and other resources. Virgin Islands. This site contains a wealth of resources for providers including enrollment, billing manuals, bulletins, program regulations, plus information on Electronic Data Interchange and the Automated Eligibility Verification. We would like to show you a description here but the site won’t allow us. facilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. DUPIXENT® (dupilumab) therapy (“My Information”). Done. Welcome to RxCrossroads. Dupixent is an injection that is usually given under the skin every other week for the treatment of asthma, eczema, and some other inflammatory conditions. For more financial assistance information, dialDUPIXENT MyWay offers a range of support, including: Coverage Support (e. For patients with commercial insurance who are new to DUPIXENT and experiencing a. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. Please note that you will receive a confirmation fax after sending the form. In those situations, the Program may change its terms in order to enable patients to realize the full benefits of the assistance available under the Program. , Benefits Investigation, Prior Authorization, and Appeals Support) Patient Access Support (e. assistance programs, or other support programs • to investigate my health insurance coverage for DUPIXENT injection • to obtain prior authorization for coverage • to assist with appeals of denied claims for coverage • for the operation and administration of the DUPIXENT MyWay Program • to refer me to, or to determine my eligibility. Adbry (tralokinumab) is a member of the interleukin inhibitors drug class and is commonly used for Atopic Dermatitis. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. Providers rendering services in the MA managed care delivery system. The program is intended to help patients afford DUPIXENT. If you need help paying for your prescription, the DUPIXENT MyWay Patient Assistance. Contact Us. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as a $0* copay per fill of DUPIXENT, maximum of $13,000 per patient per calendar year. The DUPIXENT MyWay nurse connects patients to a variety of helpful resources, including one-on-one nursing support, financial assistance for eligible patients, and helpful refill and injection reminders. Get your personalized discussion guide to help yourself have a productive conversation with your doctor & see if DUPIXENT® (dupilumab) for uncontrolled moderate-to-severe atopic dermatitis is right for you. Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI, and demonstrate a financial need. *. This component of the program is made possible through Sanofi Cares North America. Dupixent. I certify that I have obtained my patient’s written authorization in accordance with applicable If you’ve had a discussion with your healthcare provider about DUPIXENT or have been prescribed DUPIXENT, register online today to talk one-on-one with trained Patient or Caregiver DUPIXENT Mentors to discuss life with moderate-to-severe asthma and hear about their personal journey with DUPIXENT. You may be eligible for the DUPIXENT MyWay Copay Card if you:. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1,. Learn more about DUPIXENT® (dupilumab), is the first FDA-approved biologic to treat eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg). consent to receive text messages by or on behalf of the Program. Paul, MN 55164-0811 . 5. by McKesson's Portal! RxCrossroads is pleased to provide you with fast, reliable assistance in obtaining medication copay saving offerings. Fill a 90-Day Supply to Save. 90. Program: BC Palliative Care Benefits. I'm fortunate enough to have really good insurance but my friend isn't and he gets his dupixent through the no insurance program at low/no costThe $0 Copay Card reduces monthly copays to $0 for insured patients, and the Amgen Patient Assistance Program can help provide no-cost medication for patients who qualify. How to apply. Patients will need to meet the eligibility criteria, including household income, to qualify. I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. In those situations, the program may change its terms. free under the Program. How do I submit the application? The completed application can be submitted by fax (800-784-9950), mail (XHANCE Patient Assistance, 2325 Heritage Center Drive, Furlong, PA 18925), email ([email protected] programs, or other support programs • to investigate my health insurance coverage for DUPIXENT injection • to obtain prior authorization for coverage • to assist with appeals of denied claims for coverage • for the operation and administration of the DUPIXENT MyWay Program • to refer me to, or to determine my eligibility. g. Dupixent Enhanced SGM - 7/2020. 2023, in observance of Thanksgiving. You can connect with DUPIXENT MyWay Nurse Educators by phone to receive supplemental injection training, help scheduling deliveries and prescription refills, or help navigating financial support options, such as copay assistance. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. A patient assistance program called GSK for You is available for Nucala. Contact program for details. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the. Sign up with NeedyMeds' partner Savvy. Proponents say that in an age of increasingly high deductibles and coinsurance charges, such help from the manufacturer is the only way. Please click on the link to see if you may qualify. ago. It may be covered by your Medicare or insurance plan. facilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. , One-on-One Nurse Education, and Supplemental Injection Training)Any savings provided by the program may vary depending on patients' out-of-pocket costs. Y. I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Kozak, Deputy Secretary Office of Medical Assistance Programs IMPORTANT REMINDER: All providers must revalidate the Medical Assistance (MA) enrollment of each service location every 5 years. Helminth infections (5 cases of. CMAP will not pay for prescriptions written by a non-enrolled provider. DUPIXENT 200 mg injections at different injection sites. TRICARE, or other federal or state programs including any state pharmaceutical assistance programs. DUPIXENT® (dupilumab) is indicated for the treatment of patients aged 6 years and older with uncontrolled moderate-to-severe atopic dermatitis. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the type 2 inflammation that plays a major role in multiple related and often co-morbid diseases. Paris and Tarrytown, N. , February 26, 2022. LEARN HOW WE CAN HELP DUPIXENT MyWay ENROLLMENT FORMS; FOR ALLERGISTS: English Enrollment Form:The DUPIXENT MyWay Copay Card Program includes the Copay Card, the Debit Card, and any direct patient rebate, and has a combined annual maximum benefit of $13,000 per patient per calendar year. 2. For more information and to find out whether you’re eligible for support, call 844-468-2252 or visit the program website . I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the “DUPIXENT MyWay Program,” including: • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistanceSanofi Patient Connection ® can provide certain Sanofi prescription medications at no cost if you meet program eligibility requirements. Help navigate financial support options, such as copay assistance; Contact 1‑844‑DUPIXENT (1‑844‑387‑4936) to speak to a DUPIXENT MyWay Case Manager or representative if. Injection Support Center Injection Reminders and Tips FREQUENTLY ASKED QUESTIONS; Español. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the Program. Is the patient currently receiving Dupixent through samples or a manufacturer’s patient assistance program?DUPIXENT® (dupilumab) therapy (“My Information”). Experience: Been on Dupixent since May 15, 2017. SYNVISC ® OnTRACK: 1-800-796-7991. g. 48 SavedWith NeedyMeds Drug Card. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. Learn how to inject DUPIXENT® (dupilumab), a biologic subcutaneous injectable prescription medicine for eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg). S. Program has an annual maximum of $13,000. DUPIXENT can cause allergic reactions that can sometimes be severe. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. Exploring Alternative Assistance Programs. Prescription Hope charges a service fee of $60. Choose My Signature. Patient is responsible for any out-of-pocket amounts that exceed the program limit. DUPIXENT is not a steroid or immunosuppressant; it is a prescription biologic medicine given under the skin (subcutaneous injection). That’s why we offer patient assistance programs that provide free AbbVie medicines to qualifying patients. How possessed an annual upper of $13,000. DUPIXENT® (dupilumab) is a. could be spending on patient care. Paris and Tarrytown, N. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the “DUPIXENT MyWay Program,” including: • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistance Medicaid, or any other state or federal programs unless you choose not to use your government-sponsored program. Agency: Ministry of Health. Automate the review and validation of. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am. Plenty of videos on YouTube for further education. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help scheduling deliveries The Program is intended to help patients access DUPIXENT. 2 cartons. In those situations, the program may change its terms. O. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. Have commercial insurance, including health insurance. Box 52080 MC 139 Phoenix, AZ 85072-2080 Attn. For questions call 1-888-602-2978 Copay accumulators are programs being adopted by health insurance companies to prevent payments from copay assistance programs like Dupixent MyWay from counting towards your insurance deductible and out-of-pocket maximum. Contact the program for details: Re-application: New application yearly : Additional Information: Co-payment assistance, and patient assistance programs are available for eligible patients. Dupixent has a couple of programs to help pay for it. Dupixent is a prescription drug that treats eczema, asthma, and sinusitis in adults and certain children. chevron_right. Y. DUPIXENT® is the first and only prescription medicine for eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg). Sanofi Patient Connection® is a program to help connect you at no cost to the medications and resources you need. DUPIXENT MyWay is a patient support program designed to help you get access to DUPIXENT and stay on track while providing helpful tools and resources. Alliance partners program Become an advocate Support PAN. If you are experiencing difficulty and need assistance applying online, please call 1-866-SANOFI2 (1-866-726-6342) or click here. I knew ahead of time that I would need to use the dupixent assistance program, so I’m ready for that. It also offers financial assistance for eligible patients, one-on-one nursing support, and more. They’ll help you: Track the status of PAP applications. About the Dupixent COPD Phase 3 Trial Program BOREAS is one of two pivotal trials in the Dupixent COPD program. These programs and tips can help make your prescription more affordable. Additionally, many insurance companies offer copay assistance programs to help offset the cost of the drug. MyPraluent Coach: 1-866-772-5836 or info@mypraluentcoach. Actual costs to patients, payers, and health systems are anticipated to be lower because the WAC pricing does not reflect discounts, rebates, or patient assistance programs. These diseases include approved indications for. DUPIXENT® is a prescription medicine used as an add-on maintenance treatment for uncontrolled moderate-to-severe eosinophilic or oral steroid dependent asthma in people aged 6 years and older. Copay amounts after applying copay assistance may depend on the patient’s insurance. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1,. Is the request for a continuation of therapy with Dupixent? Yes No If No, skip to #23 20. 5. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. Find information on insurance coverage, ordering through a specialty pharmacy, and the cost of DUPIXENT® (dupilumab), a prescription medicine FDA-approved to treat five conditions. A DUPIXENT MyWay Nurse Educator can help qualified patients explore additional options to help cover the cost of DUPIXENT. About Dupixent Dupixent is a fully human monoclonal antibody that inhibits the signaling of the IL-4 and IL-13 pathways and is not an immunosuppressant. Help navigate financial support options, such as copay assistance; Contact 1‑844‑DUPIXENT (1‑844‑387‑4936) to speak to a DUPIXENT MyWay Case Manager or representative if. DUPIXENT® (dupilumab) offers webinars where you can learn from medical professionals and people who live with eosinophilic esophagitis (EoE). S. Providers rendering services to MA beneficiaries in the managed care delivery system should A program called Dupixent MyWay provides a manufacturer coupon copay card. For more information and to find out if you’re eligible for support, call 844-387-4936 or visit the program website. DUPIXENT can be used with or without topical corticosteroids. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. You can connect with DUPIXENT MyWay Nurse Educators by phone to receive supplemental injection training, help scheduling deliveries and prescription refills, or help navigating financial support options, such as copay assistance. DUPIXENT MyWay. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. The insurance companies do this by looking at where the money to pay a copay is coming from. Patient assistance program. coverage assistance programs, patient assistance programs, or other support programs • to investigate my health insurance coverage for DUPIXENT inection • to obtain prior authorization for coverage • to assist with appeals of denied claims for coverage • for the operation and administration of the DUPIXENT MyWay Programfacilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. Check eligibility (PDF 0. Patient has ONE of the following: a. ” but i don’t know if having insurance with a copay accumulator is the same thing as insurance not. You can do this by applying online or calling us at 1 (877)386-0206. FWIW I pay my copay out of pocket and then submit the receipt to the Dupixent MyWay Reimbursement Program through the mail. Your doctor or nurse practitioner fills out and submits the application for you. I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. S. consent to receive text messages by or on behalf of the Program. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. , One-on-One Nurse Education, and Supplemental Injection Training) Through the Patient Assistance Program, qualified patients who are uninsured or whose insurance does not cover DUPIXENT could receive DUPIXENT at no cost. A patient may self-inject DUPIXENT after training in subcutaneous injection technique using the pre-filled syringe. For more information, dial 1-844-DUPIXENT 1-844-387-4936 ), option 5, Monday-Friday, 9 am – 9 pm ET. I know my Co. Patient assistance program. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. Please see Important Safety. To learn more and see whether you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the manufacturer’s website. Medicine Assistance Tool;. consent to receive text messages by or on behalf of the Program. Find DUPIXENT® (dupilumab) injection videos and instructions for the pre-filled syringe (200 mg or 300 mg) with needle shield for ages 6 months & older. Contact the program for details: Re-application: New application yearly : Additional Information: Co-payment assistance, and patient assistance programs are available for eligible patients. With Optum Rx. DUPIXENT MyWay reserves the right to. evaluate this and other Ministry programs, and (c) to manage and plan for the health. Patients will need to meet the eligibility criteria, including household income, to qualify. Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI, and demonstrate a financial need. These diseases include approved indications for. To learn more about saving money on. Serious side effects can occur. The variable copay program applies to a select list of 200 drugs — representing more than 90% of the copay assistance available today — when dispensed through Optum Specialty Pharmacy. LEARN HOW WE CAN HELP DUPIXENT MyWay ENROLLMENT FORMS; FOR DERMATOLOGISTS: English Enrollment Form. This site provides important information to health care providers about the Connecticut Medical Assistance Program. Eligible patients may receive Dupixent for. You may be eligible for the DUPIXENT MyWay Copay Card if you:. Ways to save on Dupixent. The most common side effects include: DUPIXENT MyWay. Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI, and demonstrate a financial need. As a reminder, with all of these folks helping to get you off to good start with DUPIXENT, you may receive phone calls from your doctor. e. Dupixent. For pediatric patients aged 6 to 11 years, Dupixent dosing is based on weight (100 mg every two weeks or 300 mg every four weeks for children ≥15 to <30 kg, and 200 mg every two weeks for children ≥30 kg) and is supplied as a pre-filled syringe. Sign up now for access to a full range of services and support, like access to a COSENTYX ® Connect Team Member, the COSENTYX ® Connect Co-Pay Program and pay as little as $0 co-pay if eligible,* and injection. Save time and money by verifying benefits and copays before services are rendered. Pricing Principles;. Dupixent Patient Assistance Programs. Teva Pharmaceuticals (QVAR ®) Teva Cares Foundation Teva Savings Card for QVAR® Redihaler™ 877-237-4881 DUPIXENT® (dupilumab) therapy (“My Information”). The program is intended to help patients afford DUPIXENT. DUPIXENT MyWay TM will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket costs. Providing free or subsidized treatment for eligible patients with no. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older, with uncontrolled, moderate-to-severe eczema (atopic dermatitis). With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. You must have an annual household income of ≤400% of the. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. Call 855-204-2410 if you need assistance. You earn extra money, and NeedyMeds earns funding. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1,. g. Ask the prescriber about patient assistance. The program is intended to help patients afford DUPIXENT. I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the “DUPIXENT MyWay Program,” including: • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistanceWe would like to show you a description here but the site won’t allow us. In order to be eligible for the program, you must meet the following requirements: facilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the program. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am. g. Dupixent 200 mg – wait for at least 30 minutes. 1-Member cost share payments for these medications, whether made by you, your plan or a manufacturer copayment assistance program, do not count towa rds the plan’s out of pocket. 90. In addition, you cannot use this card with any health insurance program, but you can use it in place of your insurance if the Customer Care card offers a better price. Especially tell your healthcare provider if you. Any savings provided by the program may vary depending on patients' out-of-pocket costs. I understand and acknowledge that PASS may revise, change, or terminate any program services at any time without notice to me. If patients become infected while receiving treatment with DUPIXENT and do not respond to anti-helminth treatment, discontinue treatment with DUPIXENT until the infection resolves. 1,000-125=875 $875 is the amount your health insurance pays. The DUPIXENT MyWay Patient Assistance Program may be able to help. Dupixent Dupixent is a drug used to treat eczema and asthma. Has the patient achieved or maintained positive clinical response as evidenced by improvement in signs andDUPIXENT® (dupilumab) is a subcutaneous injectable medication used in the treatment of patients aged 6 years and older with uncontrolled moderate-to-severe atopic dermatitis with two delivery options available, pre-filled syringe & pre-filled pen (aged 12+ years). I also understand that no free product may be submitted for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. The DUPIXENT MyWay nurse connects patients to a variety of helpful resources, including one-on-one nursing support, financial assistance for eligible patients, and helpful refill and injection reminders. Our Patient Assistance Programs are intended for people that live in the United States, have limited or no health insurance coverage and demonstrate qualifying financial need. If you need help paying for your prescription, the DUPIXENT MyWay Patient Assistance Program may be able to help. Eligibility requirements for each. The Mission of the Nevada Check Up program is to provide low-cost, comprehensive health care coverage to low. Manufacturers have generous assistance programs that often exceed what most non-profit foundations can offer, particularly for commercially insured patients. * DUPIXENT ® is the only biologic medicine approved by Health Canada to treat moderate-to-severe atopic dermatitis. Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am. Within 24 hours, one of our patient advocates will call you to conduct an interview. The DUPIXENT pre-filled syringe is for use in adult and pediatric patients aged 6 months and older. And, if you're eligible, you can sign up and receive your card today. DUPIXENT® (dupilumab) is taken as an injection by a pre-filled syringe or pre-filled pen. Providers should log into PROMISe to check the revalidation dates of. g. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. At a time when the cost of specialty medications accounts for over 50 percent of pharmacy spend, it’s never been more urgent to find a solution to this growing problem. Patient Assistance Foundations; Pricing Principles. Eligible patients will receive their cards by email. VO: DUPIXENT® (dupilumab) is a prescription medicine used to treat people aged 6 years and older with moderate-to-severe atopic dermatitis (eczema) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. Has the patient achieved or maintained positive clinical response as evidenced by low disease activity (i. HELPLINE (800) 503-6897; CONTACT US; ABOUT US; EN ESPANOL. Find videos and downloadable instructions for the two injection administration options available for DUPIXENT® (dupilumab), pre-filled syringe (200 mg or 300 mg) with needle shield for ages 6 months & older, or pre-filled pen (200 mg or 300 mg) for ages 2+ years. 877. Rare Together. You’ll need to become a Simplefill member for us to find you the prescription assistance you need to pay for your Dupixent. The Patient Assistance Program may be an option if your patient is uninsured or functionally uninsured, or experiences a. Provide proper training to patients and/or caregivers on the preparation and administration of DUPIXENT prior to use according to the “Instructions for. Your household income must be less than 400% of the FPL. Copay coupons are typically for expensive, brand-name medications that don’t have a. May 20, 2022. Pay as little as $0 per month. 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. or U. Every patient has unique circumstances, and no one should have to forego the medication they need because they can’t afford it. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the. I certify that I have obtained my patient’s written authorization in accordance with applicableThe DUPIXENT MyWay Patient Assistance Program may be able to help. In 2022, we assisted nearly 200,000 people. Prescriber’s Name (Last, First): Member's Name (Last, First):. Financial Eligibility;. How to get Prescription Assistance. DUPIXENT® (dupilumab) therapy (“My Information”). Will Dupixent be used in combination with another *non-topical PriorFast. It is a single-dose injection that can be taken at home after proper training once a week. The Program is intended to help patients access DUPIXENT. Study A of clinical program evaluated the efficacy and safety of Dupixent as an add-on therapy to standard-of-care antihistamines compared to antihistamines alone in 138 patients aged 6 years and. facilitate the filling of my patient’s prescription; to assess, if applicable, my patient’s eligibility for patient assistance and other support programs; and to otherwise administer DUPIXENT MyWay for the patient. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the. , One-on-One Nurse Education, and Supplemental Injection Training)3. You may be eligible for the DUPIXENT MyWay Copay Card if you:. DUPIXENT® (dupilumab)'s patient education program events let you meet other adults living with moderate-to-severe eczema (atopic dermatitis) or caregivers of a patient living with moderate-to-severe eczema (atopic dermatitis). understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. If you need help paying for your prescription, the DUPIXENT MyWay® Patient Assistance Program may be able to help. Sanofi Patient Connection ® can provide certain Sanofi prescription medications at no cost if you meet program eligibility requirements. The Dupixent development program has shown significant clinical benefit and a decrease in type 2 inflammation in Phase 3 trials, establishing that IL-4 and IL-13 are key and central drivers of the type 2 inflammation that plays a major role in multiple related and often. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. Injection Support Center Help Staying on Track DUPIXENT Pricing Information For. Eligible patients may receive Dupixent for free or at a reduced cost. SCHEDULING. During my first year on the medication (2019), it was covered fully through the MyWay Program. Serious side effects can occur. Once enrolled, you can receive: One-on-one nursing support when needed for DUPIXENT; Insurance benefit investigation support; Opportunities for financial assistance provided to eligible patients;Dupixent (dupilumab) is a prescription drug that comes as an injection. Is the request for a continuation of therapy with Dupixent? Yes No If No, skip to #23 20. I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the “DUPIXENT MyWay Program,” including: • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistancecoverage assistance programs, patient assistance . In those situations, the Program may change its terms in order to enable patients to realize the full benefits of the assistance available under the Program. I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the “DUPIXENT MyWay Program,” including: • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistance understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. Assistance may be available for patients who do not have insurance.