• DUPIXENT can be stored at room temperature up to 77°F (25°C) up to 14 days. Paul, MN 55164-0811 . Confusion, unanswered questions, and financial barriers cloud the patient experience. Sanofi and Regeneron announce FDA approval of Dupixent (dupilumab), the first targeted biologic therapy for adults with moderate-to-severe atopic. Sign up with NeedyMeds' partner Savvy. DUPIXENT MyWay offers a range of support, including: Coverage Support (e. DUPIXENT is intended for use under the guidance of a healthcare provider. g. 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 DUPIXENT MyWay is a patient support program designed to help you get access to. Serious side effects can occur. Rotate the injection site with each injection. , One-on-One Nurse Education, and Supplemental Injection Training)3. DUPIXENT® (dupilumab) therapy (“My Information”). 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,. The General Assistance (GA) program (PDF) helps people without children pay for basic needs. 2. Program has an annual maximum of $13,000. 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. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. Millions of Americans rely on copay assistance — coupons, discount cards, vouchers, and other programs — to afford their prescribed medications. Compare . 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: January 1, 2022 Subsection: Topical Products Original Policy Date: April 7, 2017 Subject: Dupixent Page: 4 of 11 2. Patient Assistance Foundations; Pricing Principles. chart notes, laboratory values) and use of claims history documenting the following: 1. 2023, in observance of Thanksgiving. Financial and insurance assistance:. 2 cartons. Even when using the Copay Card, that would cover only cover 4 months worth, and would not go towards my deductible, totaling about. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. You can be eligible for and DUPIXENT MyWay Copay Card if you:. g. You can email or print the enrollment forms below. If you need help paying for your prescription, the DUPIXENT MyWay® Patient Assistance Program may be able to help. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. Assistance may be available for patients who do not have insurance. 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. 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. 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. They will begin the benefits investigation and inform your office of the next steps. There is currently no generic alternative to Dupixent. Have a Medicare prescription drug plan. In those situations, the program may change its terms. Pricing Principles;. And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. 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. 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 Program consent to receive text messages by or on behalf of the Program. 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. Prior Authorization of Dupixent (dupilumab) – Pharmacy Services BY Sally A. 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). And while everyone’s working through the details, look to DUPIXENT MyWay for additional support. DUPIXENT® (dupilumab) is a subcutaneous injectable prescription medicine for uncontrolled moderate-to-severe eczema (atopic dermatitis) in adults & children aged 6 months & older. 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. DUPIXENT MyWay® is a patient support program that can help enable access to DUPIXENT® (dupilumab), provide financial assistance to eligible patients & offer nursing support. 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. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. Need additional guidance with the enrollment process? Contact your field access specialist or call DUPIXENT MyWay. The randomized, Phase 3, double-blind, placebo-controlled trial evaluated the efficacy and safety of Dupixent in 939 adults who. 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. Since Dupixent can be quite expensive, reimbursement programs help to mitigate the cost for eligible patients. MS One to One™ (AUBAGIO ® and LEMTRADA ®): 1-855-671-2663. 1-844-DUPIXENT 1-844-387-4936. Check the liquid in the prefilled pen or syringe. , One-on-One Nurse Education, and Supplemental Injection Training) Please click “Continue. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. , One-on-One Nurse Education, and Supplemental Injection Training) Please click “Continue. Eligibility Requirements. Biologic Drug: Biologic drugs are made from living cells and are often expensive. Is Dupixent being prescribed by or in consultation with an allergist/immunologist or a pulmonologist? Yes No 19. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help. Eligibility Requirements. Need additional guidance with the enrollment process? Contact your field access specialist or call DUPIXENT MyWay. The guidelines to determine the medical necessity of Dupixent (dupilumab) will be utilized in the fee-for-service and managed care delivery systems. . I certify that I have obtained my patient’s written authorization in accordance with applicable• Store DUPIXENT in the refrigerator at 36°F to 46°F (2°C to 8°C). , 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. 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. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of 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. consent to receive text messages by or on behalf of the Program. 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. I have private insurance which helps with some of the cost, after the co-pay assistance through Sanofi. Patients get more insight into the medication’s cost during its entire lifecycle. O. Please see Important Safety Information and Prescribing Information and Patient Information on website. You may be eligible for the DUPIXENT MyWay Copay Card if you:. Do not put the syringe into direct sunlight. designated, DUPIXENT MyWay is authorized to transmit this prescription to a network pharmacy it selects or to the pharmacy otherwise indicated. such as copay assistance. g. I certify that I have obtained my patient’s written authorization in accordance with applicable DUPIXENT® (dupilumab) therapy (“My Information”). 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. She wanted to put me on Dupixent immediately but I was breast feeding my baby. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. Injection Support Center Help Staying on Track DUPIXENT Pricing Information For. 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. 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 . Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to therapy whether they are uninsured, lack coverage, or need assistance with their out-of-pocket costs. There are. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. Assistance (MA) Program. 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. DUPIXENT MyWay offers a range of support, including: Coverage Support (e. Like many other drugs, it may be denied by the insurer for reasons that are opaque to the patient. 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. Ways to save on Dupixent. Dupixent. Box 64811 St. Providers should log into PROMISe to check the revalidation dates of. You must have an annual household income of ≤400% of the. Providers should log into PROMISe to check the revalidation dates of. Sanofi (DUPIXENT®) 844‑387‑4936 (option 1) Only if your insurance does not cover DUPIXENT. Patient assistance program. LASTING CHANGE IS ACHIEVABLE. LEARN HOW WE CAN. A causal association between DUPIXENT and these conditions has not been established. My Employer's insurance, Canada Life, was a "Smart Plan" that excluded Dupixent under their formulary. g. With of DUPIXENT MyWay Copay Card, right, commercially insured patients might pay as little as $0* copay per fill of DUPIXENT. g. 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. $125 is the amount Dupixent assistance pays. Quick Start may be able to provide DUPIXENT at no cost to help bridge patients to. ago. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 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. I received a letter from my insurance (BCBS) saying that next. Contact. Healthcare professionals should be alert to vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in patients with eosinophilia. It provides money to people who can't work enough to support themselves, and whose income and resources are very low. Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. Providers rendering services in the MA managed care delivery system. 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. PhRMA’s Medicine Assistance Tool (MAT) – Partnership for Prescription Assistance. Adbry (tralokinumab) is a member of the interleukin inhibitors drug class and is commonly used for Atopic Dermatitis. S. Paller AS, Simpson EL, Siegfried EC, et al. Any savings provided by the program may vary depending on patients’ out-of-pocket costs. To contact MyPraluent Coach™, please call 1-866-772-5836. Patients will need to meet the eligibility criteria, including household income, to qualify. chevron_right. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. The maximum annual patient benefit under the DUPIXENT MyWay® Copay Card Program is $13,000. The maximum annual patient benefit under the DUPIXENT MyWay® Copay Card Program is $13,000. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. Medicine Assistance Tool;. Dupixent is an injectable prescription medicine used to treat a number of. S. Choose My Signature. NeedyMeds is the best source of information on patient assistance programs and their applications. Serious side effects can occur. Done. People who get GA are also eligible for help with medical and food costs through Medical Assistance (MA) and the. Teva Pharmaceuticals (QVAR ®) Teva Cares Foundation Teva Savings Card for QVAR® Redihaler™ 877-237-4881 DUPIXENT® (dupilumab) therapy (“My Information”). A patient assistance program called GSK for You is available for Nucala. 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. Find the safety profile, including most common side effects, of DUPIXENT® (dupilumab) for infant to. g. 5. (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® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. 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. Pricing Principles;. by McKesson's Portal! RxCrossroads is pleased to provide you with fast, reliable assistance in obtaining medication copay saving offerings. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 1,000-125=875 $875 is the amount your health insurance pays. 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. 00 a month for each medication accessed through patient assistance programs to manage medication orders and refills. You may be able to lower your total cost by filling a greater quantity at one time. Proponents say that in an age of increasingly high deductibles and coinsurance charges, such help from the manufacturer is the only way. With this approval, Dupixent becomes the first and only medicine specifically indicated to. Drug copay assistance programs have long been controversial. Please call me at [Primary Treating Site Phone Number] if I can be of further assistance or you require additional information. DUPIXENT can be used with or without topical corticosteroids. The DUPIXENT MyWay team can research each patient’s situation and determine eligibility. Copay Reimbursement Program, 200 Jefferson Park, Whippany, NJ 07981. To help identify you in our system, please provide the following information. THE DUPIXENT MyWay 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. Additionally, many insurance companies offer copay assistance programs to help offset the cost of the drug. 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. Find help with the cost of medicine. S. Contact the program for details: Re-application: New application yearly : Additional Information: Co-payment assistance, and patient assistance programs are available for eligible patients. g. S. Easy. consent to receive text messages by or on behalf of the Program. 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. 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. S. Dupixent ® (dupilumab) is the first biologic to significantly reduce itch and skin lesions in Phase 3 trial for prurigo nodularis, demonstrating the role of type 2 inflammation in this disease. Surgery may remove your nasal polyps, but it may not treat an underlying cause of inflammation—allowing them to grow back. chart notes, laboratory values) and. To learn more and see whether you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the manufacturer’s website. If you need help paying for your prescription, the DUPIXENT MyWay® Patient Assistance Program may be able to help. DUPIXENT® (dupilumab) therapy (“My Information”). Contact the program for details: Re-application: New application yearly : Additional Information: Co-payment assistance, and patient assistance programs are available for eligible patients. Saveonsp-supported specialty medications. Contact. 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. g. Patients with Medicare Part D should contact the program. Paris and Tarrytown, N. 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. Just got the fun news that I will need to pay $2,700 for a monthly dose of Dupixent. The maximum annual patient benefit under the DUPIXENT MyWay® Copay Card Program is $13,000. 4. (800) 657-7613 Call us if you’re a pharmacist or patient looking for support. such as copay assistance. , One-on-One Nurse Education, and Supplemental Injection Training) AbbVie Patient Assistance Program. Pay as little as $0 per month. The Dupixent Patient Support Program offers free or low-cost access to Dupixent for eligible patients. The guidelines to determine the medical necessity of Dupixent (dupilumab) will be utilized in the fee-for-service delivery system and by the MA managed care organizations (MCOs) in Physical Health HealthChoices and Community HealthChoices. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. It also offers financial assistance for eligible patients, one-on-one nursing support, and more. 1‑844‑DUPIXENT 1-844-387-4936. Patient Access Network Foundation and Dupixent MyWay Program are patient assistance programs that assist underinsured and uninsured patients with access to medications such as Dupixent for free or at a saving. Eligible patients may receive Dupixent for. Provincial coverage with exception to Ontario, New Brunswick, and Quebec, do not cover Dupixent under their Provincial formulary. , Benefits Investigation, Prior Authorization, and Appeals Support) Patient Access Support (e. Patient assistance programs (PAPs) are typically sponsored by pharmaceutical companies and offer cost-free or discounted medicines, as well as copay programs, to individuals with low income or those who are uninsured/under-insured and meet specific criteria. 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. Need additional guidance with the enrollment process? Contact your field access specialist or call DUPIXENT MyWay. 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. These programs, such as patient assistance programs or manufacturer discounts, offer financial support and resources. Assistance may be available for patients who do not have. Start the process today by applying online or by calling (877)386-0206. Assistance (MA) Program. 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 treatment of eosinophilic. Eligible patients may receive Dupixent for free or at a reduced cost. chevron_right. Patient is responsible for any out-of-pocket amounts that exceed the program limit. Prurigo Nodularis: The most common adverse reactions (incidence ≥2%) are nasopharyngitis, conjunctivitis, herpes infection, dizziness, myalgia, and diarrhea. 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. Within 24 hours, one of our patient advocates will call you for a brief interview. Uninsured patients can apply to the manufacturer’s patient assistance program, the Dupixent MyWay program. 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. 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. Providing free or subsidized treatment for eligible patients with no. This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Sign up to connect with a DUPIXENT MyWay® mentor to help patients with Nasal Polyps through their DUPIXENT. Save time and money by verifying benefits and copays before services are rendered. understand that any free product distributed through the DUPIXENT MyWay Patient Assistance Program is not contingent on any purchase obligations. Compare monoclonal antibodies. Dupixent is one shot self administered every two weeks, and delivered to my door through the specialty Pharm. Have commercial insurance, including health insurance. Prescriber’s Name (Last, First): Member's Name (Last, First):. Support Program for DUPIXENT ® (dupilumab) Your healthcare provider has begun your. A program called Dupixent MyWay provides a manufacturer coupon copay card. Rare Together. *. Ask the prescriber about patient assistance. These diseases include approved indications for. It may be covered by your Medicare or insurance plan. The Dupixent MyWay program may help reduce its cost. 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. Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to. 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). DUPIXENT: your first choice to adequately control this chronic, systemic disease. 18. DUPIXENT can be used with or without topical corticosteroids. That’s why we offer patient assistance programs that provide free AbbVie medicines to qualifying patients. The manufacturer can provide additional information and enrollment forms. Eligible patients will receive their cards by email. 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. I certify that I have obtained my patient’s written authorization in accordance with applicable consent to receive text messages by or on behalf of the Program. territories and be under the care of a licensed healthcare provider authorized to prescribe, dispense and administer medicine in the U. Dupixent changed my life completely. Eligible patients will receive their cards by email. 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. g. 1-914-354-9001. Dupixent is a prescription drug that treats eczema, asthma, and sinusitis in adults and certain children. , Quick Start, Copay Card, and Patient Assistance Program) Nursing Support (e. Here’s what you’ll need to complete the application: Patient contact information, household income and insurance information. Copayment Assistance Organizations. Y. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. 44, leaving me with $570 OOP. g. C M ET DUPIXENT MYWAY ENROLLMENT FORM Moderate-to-Severe Atopic Dermatitis SUBMIT COMPLETED PAGES 1 & 2 Fax: 1-844-387-9370 Document Drop: (code: 8443879370) 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 Program THE DUPIXENT MyWay PROGRAM. The upper arm can also be used if a caregiver administers the injection. 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. Patients prescribed Praluent® may have access to the following program services: product administration training, treatment reminders, reimbursement navigation, copay assistance and a toll-free call center. Especially tell your healthcare provider if you. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the Program. DUPIXENT MyWay ENROLLMENT FORMS; English Enrollment Form. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the program. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. Do not keep Dupixent at room temperature for more than 14 days. Patient Assistance & Copay Programs for Dupixent. 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®. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. Complete the At Home Program Application form with the assistance of a physician. In 2022, we assisted nearly 200,000 people. Injection site reactions and eye conditions are the most common side effects reported and, unlike several other biologics, the risk of infection is low. Compare monoclonal antibodies. Acaregiver or patient 12 years of age and older may inject DUPIXENT using the pre-filled syringe or pre-filled pen. , Benefits Investigation, Prior Authorization, and Appeals Support) Patient Access Support (e. Prior to Dupixent therapy, what was the patient’s baseline (e. The DUPIXENT MyWay Patient Assistance Program may be able to help. consent to receive text messages by or on behalf of the Program. Paris and Tarrytown, N. All our information is free and updated regularly. 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). For families/households with more than 8 persons, add $5,140 for each. The U. It is free to apply, and those who qualify will receive their medicine for free — no co-pays or shipping costs. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Please see Important Safety Information and Patient Information on. DUPIXENT MyWay is a patient support program that can help enable access to DUPIXENT and offers financial assistance for eligible patients, one-on-one ongoing support, and more. Has the patient achieved or maintained positive clinical response as evidenced by low disease activity (i. 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. LONG-LASTING CLEARER SKIN AT 16 and 52 Weeks 22% taking. The patient is not eligible to use this copay savings card if they are enrolled in a state or federally funded prescription insurance program, including, but not limited to, Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly. • Store DUPIXENT in the original carton to protect from light. DUPIXENT (dupilumab) Prescriber Information Patient Information . 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. 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. territories. The most common side effects include: DUPIXENT MyWay. 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. , 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. Patients will need to meet the eligibility criteria, including household income, to qualify. The most common side effects include: DUPIXENT MyWay. DUPIXENT MyWay. 3 MB) Application Instructions For New Patients: Apply online through the Patient Assistance Now Oncology (PANO) program 1 800 282 7630 Patient portal |. 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. 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. We believe that people who need our medicines should be able to get them. And, if you're eligible, you can sign up and receive your card today. Please visit our Medications Available page to see if assistance. 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. Please see Important Safety. DO NOT inject DUPIXENT into skin that is tender,When filling out the DUPIXENT MyWay Enrollment Form, both you and your patient will be required to supply information, such as the patient’s insurance, diagnosis, and prescription. g. About three weeks later they send me a check to reimburse my copay. herbypablo • 23 hr. One-on-one supplemental injection support training with nurse educators in person, virtually, or by phone. DUPIXENT® (dupilumab) is taken as an injection by a pre-filled syringe or pre-filled pen. or U. Please see. Ask the prescriber about patient assistance. Providers should log into PROMISe to check the revalidation dates of. If you are experiencing difficulty and need assistance applying online, please call 1-866-SANOFI2 (1-866-726-6342) or click here. Please note that you will receive a confirmation fax after sending the form. Program: BC Palliative Care Benefits. 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. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. Have commercial insurance, including health insurance. Serious side effects can occur. 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 ProgramDUPIXENT® (dupilumab) therapy (“My Information”). DUPIXENT® (dupilumab) is a. Contact Us. 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. Will Dupixent be used in combination with another *non-topical PriorFast. Dupilumab in children aged 6 months to younger than 6 years with uncontrolled atopic dermatitis: a randomised, double-blind, placebo-controlled, phase 3 trial. Author: SOTO, TIANADupixent – FEP MD Fax Form Revised 10/28/2022 Send completed form to: Service Benefit Plan Prior Approval P.