Patient Assistance Program. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. Section 5a. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. Dupixent is currently approved in the U. ithdrawal of this Authoriation will end my participation in the DUPIXENT MyWay Program and will not aect any disclosure of My Information ased on this Authoriation made efore my reuest is received and processed y my ealthcare Providers, ealth Insurers, and Specialty Pharmacies. Section 5a. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. (DUPIXENT + Topical Corticosteroids (TCS) vs TCS only): CLEAR OR ALMOST CLEAR SKIN AT 16 Weeks 39% taking DUPIXENT + TCS vs 12% using TCS only. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T)(1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. A group of skin conditions characterized by skin inflammation, rash, and itch. Clip the card and save • Save up to 80% on medications* Tell your healthcare provider about any new or worsening joint symptoms. My doctor gave me a copay card to cover mine. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay, and that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. 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). That is good, because I was quoted 1400+ a month by my Medicare D provider. On dupixent, Dupilumab, I honestly felt I was in my 60 to 70s+ with joint pains throughout my entire body even into the smallest of joints like fingers. 17 and 0. 2022;400 (10356):908-919. Susie16 Aug 29, 2023 • 2:03 AM. It’s a change in how copay assistance and coupons are counted toward your. DUPIXENT ® is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins 3 and is not an immunosuppressant. It will also depend on how much you have. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded. DUPIXENT is a prescription medicine used as an add-on maintenance treatment for adults and children 6 years of age and older who have moderate-to-severe eosinophilic or oral steroid dependent asthma that is not controlled with their current asthma medicines. That is what I am in the middle of. Eligible patients or caregivers of a patient must be: *For more information, dial 1-844-DUPIXENT 1-844-387-4936 option 5, Monday-Friday, 9 am - 9 pm ET. DUPIXENT® (dupilumab) Prescription Information Quick Start may be able to provide DUPIXENT at no cost to help bridge patients to therapy if there is a coverage delay. Patient to Fill Out. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. TEL: 844. Maximum benefit (2023) = $1,483. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. 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). 01. Eligible patients will receive their cards by email. Serious side effects can occur. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. Your cost may depend on your treatment plan, your insurance coverage (if you have it), and the pharmacy you use. I have read and agree to the Income Verification included in Section 8 on page 5. DUPIXENT® (dupilumab) is a. 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. Fill out sections 5a and 5b completely to determine patient eligibility. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. In an open-label extension study, the long-term safety profile of DUPIXENT ± TCS in pediatric patients observed through Week 52 was consistent with that seen in adults with. Nurse Educators Nurse Educators offer one-on-one support to help patients start and stay on track with therapy. Section 5a. including household income, to qualify. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Patient has been compliant on Dupixent therapy 4. ) I agree that Regeneron Pharmaceuticals, Inc. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Insurance Information Insurance? Yes No If yes, is it Medicare Part D? Primary insurance name Secondary insurance nameDupixent myway income limits 2022; where to buy authentic kf94 masks;. g. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. 99% of commercial patients (6+ months of age) nationally are covered for DUPIXENT. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Surgery may remove your nasal polyps, but it may not treat an underlying cause of inflammation—allowing them to grow back. comfysnail • 1 yr. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. 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. For more information, call 1. Follow these tips to take DUPIXENT while traveling: Store DUPIXENT in the original carton to protect it from light. ithdrawal of this Authoriation will end my participation in the DUPIXENT MyWay Program and will not aect any disclosure of My Information ased on this Authoriation made efore my reuest is received and processed y my ealthcare Providers, ealth Insurers, and Specialty Pharmacies. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. Also, make sure to store the DUPIXENT MyWay phone number in your phone’s contacts so you. VO: DUPIXENT 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. If you have an adjusted net income or adjusted household net income between $30,000 and $32,000, you may receive a reduced supplement amount. 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. Serious side effects can occur. Does anyone know the eligibility process for the dupixent copay assistance? Do they ask for tax forms? Is there an income limit? comments sorted by Best Top New Controversial Q&A Add a Comment More posts you may like. Patient assistance program. $125 is the amount Dupixent assistance pays. 02. Use DUPIXENT exactly as prescribed by your doctor. Registered nurses are also available to speak with eligible patients about DUPIXENT. If you are a New York prescriber, please use an original New York State. PRESCRIBER TO FILL OUT 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) Education and Nurse Support: One-on-one nursing support is available to educate and empower patients to use DUPIXENT as prescribed. 1. I’ve been with DUPIXENT MyWay since the very beginning. Learn why DUPIXENT® (dupilumab) may be an. 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 refrigerator at 36°F to 46°F (2°C to 8°C). 1kg over one year – the amount of weight gained ranged from 0. For Healthcare Professionals. Each time you fill your DUPIXENT prescription, please ensure your. Serious adverse reactions may. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 2 pens of 300mg/2ml. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notOnce you’ve been prescribed DUPIXENT, your healthcare provider can download the enrollment form, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. DUPIXENT can be used with or without topical corticosteroids. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and. Lancet. a,b a Data on file, Sanofi and Regeneron, US. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. *For patients on DUPIXENT 300 mg in a 24-week and a 52-week clinical trial vs 17% for placebo group. O. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. You may be eligibility on the DUPIXENT MyWay Copay Card if you:DUPIXENT MyWay Copay Card if you:Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. If this is the case, write the preferred specialty pharmacy name and then check the box indicating that you have sent the prescription to the specialty pharmacy, which will. In clinical trials, DUPIXENT reduced the. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. Dupixent® (dupilumab) approved by FDA as the first and only treatment indicated for prurigo nodularis Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3. S. Eligible commercially insured patients may pay $0 per prescription with a maximum savings of $13,000 per year; for additional information contact the program at 844-387-4936. 03. This DUPIXENT Pre-filled Pen is a single-dose device. Gather all necessary information and documents, such as your insurance information, prescription details, and any supporting documentation. 67 mL, 200 mg/1. 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. 67 mL, 200 mg/1. 0156 Past Update: March 2023 DUP. . I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Ready to connect with actual patients and caregivers being treated with DUPIXENT? The DUPIXENT MyWay Mentor Program helps put current and prospective moderate-to-severe eczema (atopic dermatitis or AD) DUPIXENT patients in contact with people going through similar. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 33% and 27% reduction in their nasal polyps score compared to a 7% and 4% increase with placebo in SINUS-24 and SINUS-52, respectively (LS mean change from baseline of -1. The language of the MyWay program back then never mentioned the $13,000 limit: they simply asked for income requirements, etc. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay, and that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Rx: DUPIXENT® (dupilumab) (100 mg/0. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. DUPIXENT can be used with or without topical corticosteroids. ) 2 Prescription InformationDUPIXENT is not a steroid. 0kg. 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. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. Fill out sections 5a and 5b completely to determine patient eligibility. Serious adverse reactions may occur. 80). DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. My insurance plan only covers a small amount of it with the rest being carried by the Copay program, which has a limit per year. You don’t have to put your life on hold to fit your dosing schedule. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. It's like $35k-$40k. 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. 23. Dupixent is indicated for the treatment of severe atopic dermatitis in patients aged 6 to 11Dupilumab. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and processed by my Healthcare Providers, Health Insurers, 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. Form more information phone: 844-387-4936 or Visit website Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. Also if your insurance does cover,Dupixent offers a co-pay card that. Rx: DUPIXENT® (dupilumab) (100 mg/0. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. $4,930. March 27, 2018. (The patient is lucky / unlucky enough to have an income that would rule out the Patient Assistance Program. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials. DUPIXENT can be used with or without topical corticosteroids. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. “Eczema otherwise unspecified” is not indicated for Dupixent. b Data as of January 2023. You may be eligible for the DUPIXENT MyWayDUPIXENT MyWayAbout Dupixent Dupixent is administered as an injection under the skin (subcutaneous injection) at different injection sites. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. LH Patient View; data through June 16, 2023. Rx: DUPIXENT® (dupilumab) (100 mg/0. DUPIXENT should not be stored above 77 °F (25 °C). Lot EXP Mfd. for DUPIXENT® dupilumab therapy My Information. Since 2017, Dupixent has increased in price by 13%. DUPIXENT can be used with or without topical corticosteroids. Not valid for prescriptions paid, in whole or in part, by Medicaid, Medicare, VA, DOD, TRICARE, or. Biologic Drug: Biologic drugs are made from living cells and are often expensive. Upon receipt of the completed Enrollment Form, DUPIXENT MyWay will: Conduct a benefits investigation to confirm commercial coverage Assess if the patient meets the eligibility criteria for the Quick Start Program 1 2 Approve the patient (if they are eligible). Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. DUPIXENT® (dupilumab), in moderate-to-severe asthma treatment, is taken as an injection by a pre-filled syringe or pre-filled pen, review both options here. S. 03. 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. 38]). 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. Have commercial insurance, including health insurance. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. Monday-Friday, 8 am-9 pm ET. Dupixent is not intended for episodic use. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. Please see Dosage Regimens, How to Inject DUPIXENT® and Instructions for Use. When I was very young, I knew that I wanted to be a nurse. ) I agree that Regeneron Pharmaceuticals, Inc. Continuation in the DUPIXENT MyWay Patient Assistance Program is conditioned upon timely verification of income. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. Program has an annual maximum of $13,000. Approximately 72% of the total FEV 1 improvement (470 mL improvement at Week 52 from baseline FEV 1 of 1. If you still have questions, you can speak with a DUPIXENT MyWay representative or request to join the program over the phone. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. Serious adverse reactions may. Robocalls increase diabetic retinopathy screenings in low-income patients. DUPIXENT MyWay®. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. for DUPIXENT® dupilumab therapy My Information. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 50 for a single person. Enroll now to receive emails and resources designed to help patients, caregivers and information seekers through the DUPIXENT® (dupilumab) treatment journey. Injection Support Center Injection Reminders and Tips FREQUENTLY ASKED QUESTIONS; Español. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. Patient Signature _____ If you have questions about the . In a clinical trial at 16 weeks in teens (aged 12-17 years) taking DUPIXENT* when used alone compared to teens not taking DUPIXENT: Clearer skinSAW CLEAR or Almost clear SKIN 24% vs 2% not taking DUPIXENT (placebo) nOTICEABLY LESS ITCHEXPERIENCED ITCH 37% vs 5% not taking DUPIXENT (placebo) ≥75%SKIN. I just started this week so I look forward to seeing the results. Please see. 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. 01. (2 of 3) Patient signature/Legal representative if patient is <18 years Date Section 2. ®DUPIXENT (dupilumab) Prescription Information Prescriber Certification: My signature certifies that the person named on this form is my patient; the information provided on this application, to the best of my knowledge, is complete and accurate; that therapy with DUPIXENT is medically necessary; and that I. a ®® ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pmAdditionally, Dupixent MyWay TM offers personalized support from registered nurses and other specialists who are available 24/7 to speak with patients and help them navigate the complex insurance process. Compare monoclonal antibodies. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of. Patient is responsible for any out-of-pocket amounts that exceed the program limit. I just spoke to someone through the MyWay Program. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Advertisement. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. LEARN ABOUT OUR PATIENT SUPPORT PROGRAM. Please see Important Safety Information and full PI on website. The doctor's office called to say I need to call to talk about my income and expenses. If I am completing Section 5b, I authorize for my commercially insured patient one. There is currently no generic alternative to Dupixent. DUPIXENT® is indicated as an add-on maintenance treatment of adult and pediatric patients 6 years and older with moderate-to-severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. Dupixent MyWay pays the $500 copay. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. if speciality. For more information, dial 1. 00 copay. These programs and tips can help make your prescription more affordable. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. Additionally, Dupixent MyWay ™ offers personalized support from registered nurses and other specialists who are available 24/7 to speak with patients and help them navigate the complex insurance. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and. Experience: Been on Dupixent since May 15, 2017. com, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370 • You or your healthcare provider can call 1-844-DUPIXEN(T), option 1 • Providing your email address allows DUPIXENT MyWay to give you more support resources about DUPIXENT HAS YOUR DOCTOR PRESCRIBED DUPIXENT ® (dupilumab)? 14 15. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Compare . DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. 00. any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. 0129 Last Update:. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. 14 mL, or 300 mg/2 mL)Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. Eligible patients will receive their cards by email. DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. DUPIXENT MyWay is a patient support program that can help enable access to DUPIXENT and offers financial assistance to eligible patients, one-on-one nursing support, and. Fill a 90-Day Supply to Save. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. 1, 2022, the gross income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility in Minnesota increased from 165% to 200% of the federal poverty line for most households. Sign up or activate your card here. Sanofi and Regeneron are committed to helping patients in the U. Serious side effects can occur. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. 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) 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. So the nurse told me to fax receipts for year to date prescriptions and last year's income forms (W2, 1099, etc). This copay card may be for you if you. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. withdraw this Authorization at any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. 14 mL, or 300 mg/2 mL) Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded; DUPIXENT should not be exposed to heat or direct sunlight; Do NOT freeze. Social Security income, unemployment insurance benefits, disability income, any other income for the household. Dupixent (dupilamab) Dupixent MyWay patient support program. 03. Support. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. How many people live in your household? _____ Please refer to. Especially tell your healthcare provider if you. Household Income. If necessary, DUPIXENT may be kept at room temperature up to 77 °F (25 °C) for a maximum of 14 days. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. For patients with commercial insurance who are new to DUPIXENT and experiencing a. any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. THE DUPIXENT MyWay PROGRAM. You have to game the system instead of trying to get full coverage. United Healthcare covers it but I get insurance through my employer and it was a huge pain to get approved. b New adult and pediatric patients aged 6 years and older with moderate-to-severeSection 5a. E. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. DUPIXENT MyWay ENROLLMENT FORMS; English Enrollment Form. 22. Depends if your insurance cares that Dupixent myway is paying your deductible. Edit your dupixent myway enrollment form online. It still covers the same amount. Dupixent is indicated for the treatment of moderate to severe atopic dermatitis in patients aged 12 years and older who are candidates for chronic systemic therapy. 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 programs, or other 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm This will allow the specialty pharmacy to conduct the benefits investigation, and DUPIXENT MyWay will provide additional support to the patient. Ways to save on Dupixent. Serious adverse reactions may occur. Coverage varies by type and plan. 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–9 pm ET Patient Name DOB Prescriber. will not conduct a benefits verification. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Dupixent will run about $3000 per month with my insurance until my maximum is met. If you are a New York prescriber, please use an original New York State prescription form. They will begin the benefits investigation and inform your office of the next steps. You may be able to lower your total cost by filling a greater quantity at one time. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. Each time you fill your DUPIXENT prescription, please ensure your. Get emergency medical help if you have signs of an allergic reaction to Dupixent: hives, rash, itching; fever, swollen glands, joint pain; feeling light-headed, difficult breathing; swelling of your face, lips, tongue, or throat. Serious side effects can occur. • Store DUPIXENT in the original carton to protect from light. I'm guessing this will not be allowed once I'm on Medicare. The DUPIXENT MyWay nurse connects patients to a variety of considerate resources, including one-on-one nursing product, financial assistance for right patients, and helpful refill and injection reminders. Dupixent is not intended for episodic use. For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. Option 1- you have to meet your deductible without Dupixent myway. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. Prurigo Nodularis: The most common adverse reactions (incidence ≥2%) are nasopharyngitis, conjunctivitis, herpes infection, dizziness, myalgia, and diarrhea. Be sure to fill out your enrollment form completely and accurately. withdraw this Authorization at any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. DUPIXENT® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. Watch videos from experts [,download materials,] and explore future events to further understand DUPIXENT® (dupilumab). The Dupixent MyWay program is not available to medicare patients. Dupixent may cause serious side effects. And I would experience blurry vision, red and itchy eyes. Based on the questions answered above, you are not eligible to register for a new copay card or to activate a copay card. A program called Dupixent MyWay is available for this drug. S. 22. 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). Got off of it as soon as I realized it was getting worse with every shot after spacing them out every other month. Do not store DUPIXENT pre-filled syringes at room temperatures more than 77°F (25°C) Do not keep DUPIXENT at room temperature. Monday-Friday, 8 am-9 pm ET. Approval represents the second dermatology indication for Dupixent and fifth disease indication overall in the. 0156 Last Update: March 2023 DUP. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. DUPIXENT MyWay provides prior authorization and appeals information you may need, as well as helpful examples and guides to assist in obtaining coverage for DUPIXENT. Dupixent side effects. Program has an annual maximum of $13,000. Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. Even when using the Copay Card, that would cover only cover 4 months worth, and would not go towards my deductible, totaling about. 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. ®DUPIXENT (dupilumab) Prescription Information Prescriber Certification: My signature certifies that the person named on this form is my patient; the information provided on this application, to the best of my knowledge, is complete and accurate; that therapy with DUPIXENT is medically necessary; and that I. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. 67 mL, 200 mg/1. PRESCRIBER TO FILL OUT 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) Complete the entire form and submit pages 1-3 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–9 pm ET Enrollment Form FOR ALLERGISTS Using a mail-order specialty pharmacy might help lower the monthly cost of Dupixent. Using the drop. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. 74 (2023), plus an amount based on how much you. 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. Check the liquid in the prefilled pen or syringe. How to fill out dupixent reimbursement: 01. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Fill a 90-Day Supply to Save. Normally my copay would be about $970 per refill, but with about 12 refills per year this does not max out the Dupixent MyWay copay card.