Pricing Principles;. g. This component of the program is made possible through Sanofi Cares North America. Prior Authorization of Dupixent (dupilumab) – Pharmacy Services BY Sally A. 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. Dupilumab in children aged 6 months to younger than 6 years with uncontrolled atopic dermatitis: a randomised, double-blind, placebo-controlled, phase 3 trial. 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. 3 MB) Application Instructions For New Patients: Apply online through the Patient Assistance Now Oncology (PANO) program 1 800 282 7630 Patient portal |. Helminth infections (5 cases of enterobiasis and 1 case of ascariasis) were reported in pediatric patients 6 to 11 years old in the pediatric asthma development program. * Public reimbursement under the Ontario Exceptional Access Program and the New. Eligible patients will receive their cards by email. 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,. One of the many programs we support is the American Lung Association’s "Kickin’ Asthma," a national, school-based asthma self-management program for children ages 11 to 16 (6th grade to 10th grade). Financial Assistance Programs. The program is intended to help patients afford DUPIXENT. These programs may be provided by national healthcare systems, insurance companies, or pharmaceutical manufacturers, and can help patients receive financial assistance or coverage for the medication. Each time you fill your DUPIXENT prescription, please ensure your. LEARN HOW WE CAN HELP DUPIXENT MyWay ENROLLMENT FORMS; English Enrollment Form: Spanish Enrollment Form. chevron_right. 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. 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. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. Call 855-204-2410 if you need assistance. I certify that I have obtained my patient’s written authorization in accordance with applicableunderstand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. Eligibility requirements for each. Sanofi and Regeneron announce FDA approval of Dupixent (dupilumab), the first targeted biologic therapy for adults with moderate-to-severe atopic. Providing free or subsidized treatment for eligible patients with no. Manufacturer Coupon. com to help recruit participants for medical surveys, focus groups, and other medical research projects. Prior Authorization of Dupixent (dupilumab) – Pharmacy Services BY Sally A. Program has an annual maximum of $13,000. Administer subcutaneous injection into the thigh or abdomen, except for the 2 inches (5 cm) around the navel. THE DUPIXENT MyWay PROGRAM. I knew ahead of time that I would need to use the dupixent assistance program, so I’m ready for that. 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. Dupixent is a prescription drug that treats eczema, asthma, and sinusitis in adults and certain children. Providers rendering services in the MA managed care delivery system. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. Through the Patient Assistance Program, eligible patients who are uninsured or whose insurance does not cover DUPIXENT could receive DUPIXENT free of charge. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. If you need help paying for your prescription, the DUPIXENT MyWay® Patient Assistance Program may be able to help. 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,. DUPIXENT MyWay. See available events. The Mission of the Nevada Check Up program is to provide low-cost, comprehensive health care coverage to low. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Patients get more insight into the medication’s cost during its entire lifecycle. Have commercial insurance, including health insurance. It also offers financial assistance for eligible patients, one-on-one nursing support, and more. chart notes, laboratory values) and use of claims history documenting the following: 1. 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. Contact. 90. O. Eligible patients will receive their cards by email. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. A DUPIXENT MyWay Nurse Educator can help qualified patients explore additional options to help cover the cost of DUPIXENT. If you’re having trouble affording Dupixent, you may be eligible for financial assistance programs. Prior Authorization of Dupixent (dupilumab) – Pharmacy Services BY Sally A. (DUPIXENT + Topical Corticosteroids (TCS) vs TCS only): CLEAR OR ALMOST CLEAR SKIN AT 16 Weeks 39% taking DUPIXENT + TCS vs 12% using TCS only. Dupixent Enhanced SGM - 7/2020. Enrolled patients have access to: 1‑844‑387‑4936. Is Dupixent being prescribed by or in consultation with an allergist/immunologist or a pulmonologist? Yes No 19. Contact the program for details: Re-application: New application yearly : Additional Information: Co-payment assistance, and patient assistance programs are available for eligible patients. 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. Plenty of videos on YouTube for further education. S. I certify that I have obtained my patient’s written authorization in accordance with applicable1‑844‑DUPIXENT 1-844-387-4936. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. DUPIXENT® is the first and only prescription medicine for eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg). Manufacturers have generous assistance programs that often exceed what most non-profit foundations can offer, particularly for commercially insured patients. Have a Medicare prescription drug plan. 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. • Store DUPIXENT in the original carton to protect from light. com), or over the phone (855-204-2410). g. brand. Eligible patients may receive Dupixent for. Is the request for a continuation of therapy with Dupixent? Yes No If No, skip to #23 20. 00 a month for each medication accessed through patient assistance programs to manage medication orders and refills. DUPIXENT is intended for use under the guidance of a healthcare provider. If you need help paying for your prescription, the DUPIXENT MyWay Patient Assistance. or U. And very recently got laid off due to Covid-19. Drug copay assistance programs have long been controversial. DUPIXENT MyWay ® is a patient support program designed to help you get access to. 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. Dupixent is one shot self administered every two weeks, and delivered to my door through the specialty Pharm. Copay coupons are typically for expensive, brand-name medications that don’t have a. In those situations, the program may change its terms. Patients will need to meet the eligibility criteria, including household income, to qualify. Click Tap to Learn MoreFollow the step-by-step instructions below to design your DuPont byway program enrollment form: Select the document you want to sign and click Upload. I don't know what medical issues your son is having, but it's likey autoimmune issues. g. Dupixent has a couple of programs to help pay for it. 0 (Pure hypercholesterolemia, including HeFH)I just spoke to someone through the MyWay Program. Is the patient currently receiving Dupixent through samples or a manufacturer’s patient assistance program? DUPIXENT® (dupilumab) therapy (“My Information”). Home; Patient Assistance Connection. Dupixent is contraindicated for breast feeding. Box 64811 St. To help identify you in our system, please provide the following information. DUPIXENT MyWay® Program Taking Dupixent. DUPIXENT® (dupilumab) is a. 4. 2 pens of 300mg/2ml. The program is intended to help patients afford DUPIXENT. Resource Number:. Dupixent MyWay ™ will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Please see Important Safety Information and Prescribing Information and Patient Information on website. NeedyMeds NeedyMeds has free information on medication and. Adbry (tralokinumab) is a member of the interleukin inhibitors drug class and is commonly used for Atopic Dermatitis. Experience: Been on Dupixent since May 15, 2017. To qualify for the GSK Patient Assistance Program, you must: Live in one of the 50 states, District of Columbia, Puerto Rico or U. coverage assistance programs, patient assistance programs, or other support programs • to investigate my health insurance coverage for DUPIXENT inection • to otain prior authoriation for coverage • to assist with appeals of denied claims for coverage • for the operation an aministration of the DUPIXENT MyWay ProgramPatient Rebate Portal. Asthma: DUPIXENT is indicated as an add-on maintenance treatment of adult and pediatric patients aged 6 years and older with moderate-to-severe asthma characterized. DUPIXENT can cause allergic reactions that can sometimes be severe. Applying to myAbbVie Assist is simple. 5. She wanted to put me on Dupixent immediately but I was breast feeding my baby. Box 52080 MC 139 Phoenix, AZ 85072-2080 Attn. information provided is for the sole use of the Program to verify my patient’s insurance coverage, to assess, if applicable, patient’s eligibility for participation in the Patient Assistance Program and to otherwise administer the Sanofi Patient Connection Program and related services. Welcome to RxCrossroads. , Benefits Investigation, Prior Authorization, and Appeals Support) Patient Access Support (e. These diseases include approved indications for. It is a single-dose injection that can be taken at home after proper training once a week. 2. The Program is intended to help patients access DUPIXENT. *. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 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. Dupixent (dupilamab) Dupixent MyWay patient support program. Patient assistance program. Y. 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. DUPIXENT in adult subjects who participated in the asthma development program as well as in adult subjects with co-morbid asthma in the CRSwNP development program. Additionally, many insurance companies offer copay assistance programs to help offset the cost of the drug. 18. Within 24 hours, one of our patient advocates will call you for a brief interview. Ask the prescriber about patient assistance. We work directly with your healthcare provider and will handle the full enrollment process on your behalf. The guidelines to determine the medical necessity of Dupixent (dupilumab) will be utilized in the fee-for-service and managed care delivery systems. I have private insurance which helps with some of the cost, after the co-pay assistance through Sanofi. Atopic Dermatitis: The most common adverse reactions (incidence ≥1%) in patients are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia. I understand and acknowledge that PASS may revise, change, or terminate any program services at any time without notice to me. Sign up to connect with a DUPIXENT MyWay® mentor to help patients with Nasal Polyps through their DUPIXENT. (844-387-4936) or visit the program website. Serious side effects can occur. The General Assistance (GA) program (PDF) helps people without children pay for basic needs. Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. , February 26, 2022. This information will ONLY be used to validate your eligibility. Learn how to enroll in prescription assistance programs (including copay and patient assistance programs) to get free or low-cost asthma medications. Not be eligible for Puerto Rico's Government Health Plan Mi Salud, or have applied and been denied. Please be aware that not all Sanofi products are covered under the Sanofi Patient Assistance program. The Dupixent MyWay program may help reduce its cost. Saveonsp-supported specialty medications. O. LEARN HOW WE CAN HELP DUPIXENT MyWay ENROLLMENT FORMS; FOR DERMATOLOGISTS: English Enrollment Form. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. , One-on-One Nurse Education, and Supplemental Injection Training)Any savings provided by the program may vary depending on patients' out-of-pocket costs. g. To learn more and see whether you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the manufacturer’s website. TRICARE, or other federal or state programs including any state pharmaceutical assistance programs. These diseases include approved indications for. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. 2 pens of 300mg/2ml. 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. g. 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. consent to receive text messages by or on behalf of the Program. Patients will need to meet the eligibility criteria, including household income, to qualify. 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. Start the process today by applying online or by calling (877)386-0206. DUPIXENT can be used with or without topical corticosteroids. 30 Section: Prescription Drugs Effective Date: July 1, 2021 Subsection: Topical Products Original Policy Date: April 7, 2017 Subject: Dupixent Page: 6 of 10 Diagnosis Patient must have the following: Chronic rhinosinusitis with nasal polyposis (CRSwNP) AND submission of medical records (e. 25%) Taro Pharma patient access. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. You can be eligible for and DUPIXENT MyWay Copay Card if you:. ca. 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. That’s why we offer patient assistance programs that provide free AbbVie medicines to qualifying patients. S. Compare monoclonal antibodies. Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. Patient Advocate Foundation's Co-Pay Relief program exists to help reduce the financial distress patients, and their families face when paying for treatment. 48 SavedWith NeedyMeds Drug Card. Dupixent. DUPIXENT: your first choice to adequately control this chronic, systemic disease. INJECTION SUPPORT. Exploring Alternative Assistance Programs. Deductible is at $3k out of pocket insurance pays 80% and at $6k insurance pays 100%. DUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. Is the request for a continuation of therapy with Dupixent? Yes No If No, skip to #23 20. Paul, MN 55164-0811 . COSENTYX ® Connect is a personalized support program for people taking or considering COSENTYX ® (secukinumab). Check the liquid in the prefilled pen or syringe. 44, leaving me with $570 OOP. 2022;400 (10356):908-919. Once I got a new job, I called Dupixent MyWay to tell them my status changed and I could now get drugs through my insurance's specialty pharmacy. For questions call 1-888-602-2978Copay 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. Healthcare professionals should be alert to vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in patients with eosinophilia. 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. Red tape, paperwork, and communication gaps hijack the time that providers. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the Program. [Summarize your reasons why DUPIXENT is medically necessary for this patient] In order for me to provide appropriate care for my patient, it is important that [Plan Name] provide adequate coverage for this treatment. The randomized, Phase 3, double-blind, placebo-controlled trial evaluated the efficacy and safety of Dupixent in 939 adults who were current or former smokers aged 40 to 80 years with moderate-to-severe COPD. consent to receive text messages by or on behalf of the Program. 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. 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. 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. Patients may be eligible for the Quick Start Program if they: • Have a valid DUPIXENT prescription for an FDA-approved indicationThe Division of Welfare and Supportive Services (DWSS) determines eligibility for the Medicaid program. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Have commercial insurance, including health insurance. Primary diagnosis (MUST select at least 1) E78. Please use our portals–available 24/7–to apply for assistance or manage your grant during this time. Provincial coverage with exception to Ontario, New Brunswick, and Quebec, do not cover Dupixent under their Provincial formulary. In adults and children 6 years and older, your initial dose of DUPIXENT is 2 injections under the skin (subcutaneous injection) at different injection sites. Providers should log into PROMISe to check the revalidation dates of. I certify that I have obtained my patient’s written authorization in accordance with applicable DUPIXENT® (dupilumab) therapy (“My Information”). 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. Please call me at [Primary Treating Site Phone Number] if I can be of further assistance or you require additional information. Quick Start may be able to provide DUPIXENT at no cost to help bridge patients to. When patients can’t afford their prescriptions, 52% seek affordability options through their provider – and 29% go without their medications 1. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the Program. 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. This program aims to educate and empower kids to manage their asthma through a fun and interactive approach. So we went over my history, I got the script and waited for a call from the pharmacy. Find Your Fund See All Funds. 90. You may be eligible for the DUPIXENT MyWay Copay Card if you:. I know my Co. The maximum annual patient benefit under the DUPIXENT MyWay® Copay Card Program is $13,000. 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,. Dupixent 200 mg – wait for at least 30 minutes. Select a tab below to get you to helpful information depending on where you are in your treatment journey. Pricing Principles;. If you are successfully enrolled in the program, we. 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. For additional information or if you have questions, contact your Field Representative or call DUPIXENT MyWay at 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am –9 pm Eastern time. Patient Assistance Foundations; Pricing Principles. Tips. 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. Therefore, the companies have launched DUPIXENT MyWay TM, a comprehensive and specialized program that provides support and services to patients throughout every step of the treatment process. 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. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. And, if you're eligible, you can sign up and receive your card today. DUPIXENT MyWay offers a range of support, including: Coverage Support (e. 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,. You’ll need to become a Simplefill member for us to find you the prescription assistance you need to pay for your Dupixent. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. g. Please see Important Safety Information and Prescribing Information and Patient. Inadequate control of asthma symptoms after a minimum of 3 months of compliant use with greater than or equal to 50% adherence with ONE of the following within the. Eligible patients will receive their cards by email. They help people afford expensive prescription medications by lowering their out-of-pocket costs. 2 cartons. 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. How we help. 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 medical condition for which it is being used. To contact MyPraluent Coach™, please call 1-866-772-5836. Pharmaceutical companies have different guidelines for eligibility. Dupixent Patient Assistance Programs. Serious side. * DUPIXENT ® is the only biologic medicine approved by Health Canada to treat moderate-to-severe atopic dermatitis. I certify that I have obtained my patient’s written authorization in accordance with applicable understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. Please note that you will receive a confirmation fax after sending the form. 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 consent to receive text messages by or on behalf of the Program. It also offers financial assistance for eligible patients, one-on-one nursing support, and more. 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. 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. Providers should log into PROMISe to check the revalidation dates of. g. Rotate the injection site with each injection. 13 hours ago · Colorado Avalanche defenseman Samuel Girard will be away from the. You may be eligible for the DUPIXENT MyWay Copay Card if you:. Pay as little as $0 per month. If we are unable to assist you with your out-of-pocket medical expenses, one of the following. Is the patient currently receiving Dupixent through samples or a manufacturer’s patient assistance program?DUPIXENT® (dupilumab) therapy (“My Information”). You may be eligible for the DUPIXENT MyWay Copay Card if you:. There is currently no generic alternative to Dupixent. Ways to save on Dupixent. Therefore, the companies have launched Dupixent MyWay ™, a comprehensive and specialized program that provides support and services to patients throughout every step of the treatment process. Patient Assistance Connection Financial Eligibility(for uninsured or functionally uninsured patients) Determine the maximum household income requirement to be considered for Patient Assistance Connection by selecting your household size and then viewing the 400% column. CMAP will not pay for prescriptions written by a non-enrolled provider. Patient has ONE of the following: a. 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. 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. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. Box 5697, Louisville, KY 40255 Monday – Friday Phone: 1-855-297-5904 Fax: 1-855-297-5905 8:30 AM – 6:00 PM ET Page 2 of 5medications on this list, whether made by you, your plan or a manufacturer’s copay assistance program, will not count toward your plan deductible. Millions of Americans rely on copay assistance — coupons, discount cards, vouchers, and other programs — to afford their prescribed medications. 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. 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. 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. May 20, 2022. * DUPIXENT ® is the only biologic medicine approved by Health Canada to treat moderate-to-severe atopic dermatitis. Decide on what kind of signature to create. Dupixent (dupilumab) Prior Authorization Request Form Caterpillar Prescription Drug Benefit Phone: 877-228-7909 Fax: 800-424-7640. Patients will need to meet the eligibility criteria, including household income, to qualify. Every patient has unique circumstances, and no one should have to forego the medication they need because they can’t afford it. 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. 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. , 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. 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. 4. 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. Assistance (MA) Program. Dupixent (dupilumab) submitted for prior authorization, as recommended by the P&T Committee, were subject to public review and comment and subsequently approved for. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. 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. Patient assistance options are available for eligible patients with commercial insurance, public insurance or no insurance. Eligible patients will receive their cards by email. We consider each application according to: the drug that is needed. So, let's just pretend the total cost is $1,000/month. The PAN Foundation is dedicated to helping patients reach their best health. Copay amounts after applying copay assistance may depend on the patient’s insurance. Food and Drug Administration (FDA) has approved Dupixent ® (dupilumab) 300 mg weekly to treat patients with eosinophilic esophagitis (EoE) aged 12 years and older, weighing at least 40 kg. Program has an annual maximum of $13,000. That’s why we offer patient assistance programs that provide free AbbVie medicines to qualifying patients. DUPIXENT MyWay offers a range of support, including: Coverage Support (e. That’s why myAbbVie Assist provides free AbbVie medicine to qualifying patients. Y. understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. I, _____, certify that the information provided for this reimbursement request is accurate to the best of my knowledge, and the product-specific copay, co-insurance, or deductible expenses requested for reimbursement were actually. Assistance (MA) Program. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. Serious side effects can occur. Sign up with NeedyMeds' partner Savvy. Needs-Based/Patient Assistance Program (PAP): This type is offered by a manufacturer sponsor or independent non-profit to help patients who meet specific financial eligibility criteria. (800) 657-7613 Call us if you’re a pharmacist or patient looking for support. Check your patients' eligibility for insurance coverage with AdvancedMD Eligibility, a web-based application that connects you to hundreds of payers. We believe that people who need our medicines should be able to get them. Please visit our Medications Available page to see if assistance. 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 insurance companies do this by looking at where the money to pay a copay is coming from. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the program. 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. 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. Dupixent MyWay is a program that provides support and resources to people prescribed Dupixent (dupilumab) to help them get the most out of their treatment. The program is intended to help patients afford DUPIXENT. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. 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. 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. , One-on-One Nurse Education, and Supplemental Injection Training) Please click “Continue. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. Through the Patient Assistance Program, qualified patients who are uninsured or whose insurance does not cover DUPIXENT could receive DUPIXENT at no cost. SCHEDULING. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. 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. 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. References.