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. You can email or print the enrollment forms below. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. There is currently no generic alternative to Dupixent. 1kg to 18. 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. Dupixent is indicated for the treatment of severe atopic dermatitis in patients aged 6 to 11Dupilumab. In order to meet the financial eligibility criteria for receiving Sanofi medication at no cost, you must have an annual household income of ≤ 400% of the current Federal Poverty Level. I just spoke to someone through the MyWay Program. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. The fax number is 1. Lancet. form on DUPIXENT. 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). 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. If you still have questions, you can speak with a DUPIXENT MyWay representative or request to join the program over the phone. 14 mL, or 300 mg/2 mL) Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. The most common side effects include: DUPIXENT MyWay. Pay as little as $0 per month. 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. If I am completing Section 5b, I authorize for my commercially insured patient one. Each time you fill your DUPIXENT prescription, please ensure your. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. Caring. We'll keep those "Instructions for Use" nearby and then lay the pre-filled syringe on a flat surface and let it naturally warm at a room temperature of less than 77°F (25°C). How do my patients enroll in <em>DUPIXENT MyWay®</em>? When filling out the DUPIXENT MyWay Enrollment Form, both you and your patient will be required to. $0 is the amount you pay. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 18, 0. living with prurigo nodularis. Sign it in a few clicks. Maximum benefit (2023) = $1,483. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Patients in each age group saw improved lung function in as little as 2 weeks. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded. DUPIXENT® (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). DUPIXENT MyWay Ambassador. You have to game the system instead of trying to get full coverage. I have a $40 copay but I got the dupixent my way copay card its free for me. If your office does not use a preferred specialty pharmacy, leave the box unchecked to indicate that you would like DUPIXENT MyWay to conduct the benefits investigation on the patient’s behalf. chevron_right. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. 23. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. Copay Card or you wish to discontinue your participation, please contact us. com. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. Learn why DUPIXENT® (dupilumab) may be an. 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. Food and Drug Administration has approved Dupixent ® (dupilumab) as an add-on maintenance therapy in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid-dependent asthma. I’ve been with DUPIXENT MyWay since the very beginning. Watch videos for a supplemental demonstration on how to use and dispose of DUPIXENT® (dupilumab), a prescription medicine for subcutaneous injection. 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. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. 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. (DUPIXENT + Topical Corticosteroids (TCS) vs TCS only): CLEAR OR ALMOST CLEAR SKIN AT 16 Weeks 39% taking DUPIXENT + TCS vs 12% using TCS only. Sign it in a few clicks. 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. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. com. It still covers the same amount. Section 5a. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. A program called Dupixent MyWay is available for this drug. 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. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. S. Your cost may depend on your treatment plan, your insurance coverage (if you have it), and the pharmacy you use. for DUPIXENT® dupilumab therapy My Information. S. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. DUPIXENT® (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). Compare . DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 2 Eligible US residents with an FDA-approved prescription for DUPIXENT may pay as little as $0 copay per fill of DUPIXENT (annual maximum of $13,000). Appears that my out of pocket maximum will be $8000 through insurance. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. 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 Enrollment FormYes, it does appear that Dupixent can cause weight gain, although this is not listed as a side effect in the product information. It was a process to get into the patient assist program. 26 [95% CI: 0. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. Fill a 90-Day Supply to Save. 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. 1‑844‑DUPIXENT 1-844-387-4936. . 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. Long-term results from a clinical trial that studied DUPIXENT for 52 weeks. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notFor 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. 02. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. See All. I was given the MyWay copay card but it had a limit of $13,000/calendar year and that has been exhausted at this point. Dupixent side effects. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. Eligible clients will receive their cards by email. It contains 300 mg of DUPIXENT for injection under the skin (subcutaneous injection). Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. 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. 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. including household income, to qualify. If you are a New York prescriber, please use an original New York. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. S. Eligible patients will receive their cards by email. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. Regeneron and Sanofi are committed to helping patients in the U. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. Click Tap to Learn More 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 atopic dermatitis, with hand-foot-and-mouth disease and skin papilloma (incidence ≥2%) reported in patients 6 months to 5 years of age. DUPIXENT MyWay®. Rx: DUPIXENT® (dupilumab) (100 mg/0. Learn about the DUPIXENT® (dupilumab) mechanism of action inhibiting IL-4 and IL-13 signaling in appropriate asthma patients. ) I agree that Regeneron Pharmaceuticals, Inc. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. living with prurigo nodularis. Serious side effects can occur. Serious side effects can occur. 01. They never mentioned only covering a. 78 L) was seen at Week 2 in patients taking DUPIXENT 200 mg Q2W + SOC (n=264) (baseline blood EOS ≥300 cells/μL, QUEST, secondary endpoint). The appeal process Example letters. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. Fill out sections 5a and 5b completely to determine patient eligibility. 01. Opinions clash over private equity’s effect on dermatology. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. • Store DUPIXENT in the original carton to protect from light. Dupixent Myway . The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Deductible is at $3k out of pocket insurance pays 80% and at $6k insurance pays 100%. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials About 75,000 adults in the U. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not 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) Section 5a. You don’t have to put your life on hold to fit your dosing schedule. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. Option 1- you have to meet your deductible without Dupixent myway. 22. 0129 Last Update:. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 6 Submitting a PA request The appeal. Please see. Your insurance has to deny twice and then you can apply for patient assistance. You may be able to lower your total cost by filling a greater quantity at one time. Learn how DUPIXENT® (dupilumab), the first FDA-approved weekly injectable biologic treatment for eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg) targets a source of inflammation, which contributes to EoE. Box 5925 Mailstop 55A-220A Bridgewater, NJ 08807. S. Robocalls increase diabetic retinopathy screenings in low-income patients. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Compare monoclonal antibodies. In patients aged 6 months to 5 years, Dupixent is administered with a pre-filled syringe every four weeks based on weight (200 mg for children ≥5 to <15 kg and 300 mg for children ≥15 to <30 kg). Also if your insurance does cover,Dupixent offers a co-pay card that. S. 03. In order to meet the financial eligibility criteria for receiving Sanofi medication at no cost, you must have an annual household income of ≤ 400% of the current Federal Poverty. 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. DUPIXENT MyWay. Dupixent MyWay pays the $500 copay. 09. 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. 80). 2 pens of 300mg/2ml. 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 otherThis DUPIXENT Pre-filled Pen is only for use in adults and children aged 2 years and older. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. Dupixent. That is good, because I was quoted 1400+ a month by my Medicare D provider. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. “Eczema otherwise unspecified” is not indicated for Dupixent. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 67 mL, 200 mg/1. 0254 Last Update: February 2023 DUP. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. How to fill out dupixent reimbursement: 01. THE DUPIXENT MyWay COPAY CARD. 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. DUPIXENT® (dupilumab) is a. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Program Website : Patient Assistance Applications for DUPIXENT® dupilumab therapy My Information. I have applied for grants, financial hardships (my household income surpasses every programs caps, even with 6 children), etc and now I'm just being told to pay $3,000/month or too bad. Over 80% of insurance plans cover Dupixent, but many have restrictions. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. 1kg over one year – the amount of weight gained ranged from 0. ( 1-844-387-4936 ), option 1. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. Get a Quick Start. I was given the MyWay copay card but it had a limit of $13,000/calendar year and that has been exhausted at this point. 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. O. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. 00. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. 8K subscribers in the eczeMABs community. If requested, I agree to provide proof of income within thirty (30) days of the request. Dupixent MyWay Copay Card. Most do, some don't. Griffinej5 • 2 yr. , Sanofi US, and their affiliates and agents (together, the “Alliance”) may verifyBy checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. I wanted to go out and make a difference and help people. 1-844-DUPIXENT 1-844-387-4936. 01. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Patient Signature _____ If you have questions about the . The average cash price for a 30-day supply of Dupixent is $5,298. Income at or below: Not Published: Medical expenses can be deducted from reported income:. Injection Support Center Injection Reminders and Tips FREQUENTLY ASKED QUESTIONS; Español. Susie16 Aug 29, 2023 • 2:03 AM. Rx: DUPIXENT® (dupilumab) (100 mg/0. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Your doctor will tell you how much DUPIXENT to inject and how often to inject it. For more information or to enroll in the patient support program, contact us at: 1‑844‑DUPIXENT. Rx: DUPIXENT® (dupilumab) (100 mg/0. Especially tell your healthcare provider if you. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. I just got approved thru Dupixent my way for a year of free medication. They pay the first $13K (in a year) then when that is exhausted I will have to pay around $250 per month and the $13K starts over in January 2019. What it is used for. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notDUPIXENT MyWay may ask for proof of income at any time for the purpose of audit/verification. ®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. 2 pens of 300mg/2ml. Support. At one point, I was getting cold sores every 2 to 3 weeks consistently. Also, make sure to store the DUPIXENT MyWay phone number in your phone’s contacts so you. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. 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. For more information, call 1-844-DUPIXENT. This DUPIXENT Pre-filled Pen is a single-dose device. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. Dupixent will run about $3000 per month with my insurance until my maximum is met. And, if you're eligible, you can sign up and receive your card today. Please see Important Safety Information and Prescribing Information and Patient Information on website. Fill out sections 5a and 5b completely to determine patient eligibility. The most common side effects include: DUPIXENT MyWay. He continued with Dupixent and his symptoms had partially improved 24 weeks after their onset. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. for DUPIXENT® dupilumab therapy My Information. Select Condition Indication Moderate-to-Severe Eczema (Ages 6+ Months) Moderate-to-Severe Asthma (Ages 6+ Years) Chronic Rhinosinusitis with Nasal Polyposis (Ages 18+. For patients with commercial insurance who are new to DUPIXENT and experiencing a. 50 for a single person. Monday-Friday, 8 am-9 pm ET. Please see accompanying full Prescribing Information. 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,DUPIXENT has been prescribed to over 50,000 uncontrolled nasal polyp patients and counting! DUPIXENT is the first biologic nasal polyp treatment that’s an alternative to nasal polyp surgery. I. *For patients on DUPIXENT 300 mg in a 24-week and a 52-week clinical trial vs 17% for placebo group. If I am completing Section 5b, I authorize for my commercially insured patient one. That is what I am in the middle of. If you have any additional questions about this pricing information, please call DUPIXENT MyWay at 1-844-DUPIXENT (1-844-387-4936). Serious adverse reactions may occur. Especially tell your healthcare provider if you. Dupixent will run about $3000 per month with my insurance until my maximum is met. ago. We just need you to answer a few questions to verify your eligibility and contact information. With the Copay Card, You Could Pay as Little as $0 † The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. 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. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. 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. ) 2 Prescription InformationDUPIXENT is not a steroid. 14 mL, or 300 mg/2 mL)My insurance provider covers 85% and our Canadian version of 'MyWay' pays the remainder. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. Using the drop. 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. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on1-844-DUPIXENT 1-844-387-4936. - Rachel, DUPIXENT Patient Mentor, living with asthma. r/eczema • I wish there was an eczema simulator so others could feel what we do when they say “don’t. I'm "only" 61 now though on Dupixent MyWay copay help. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Program Website : Patient Assistance Applicationsfor DUPIXENT® dupilumab therapy My Information. 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. Patient is responsible for any out-of-pocket amounts that exceed the program limit. The language of the MyWay program back then never mentioned the $13,000 limit: they simply asked for income requirements, etc. 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. Sanofi and Regeneron are committed to helping patients in the U. 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. Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. Dedicated Dupixent MyWay Case Managers can explain information related to Dupixent. DUPIXENT® (dupilumab) is a. 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 otherI experienced cold sores and eye issues for about the first 6 months of being on Dupixent. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. a FDA approved since 2017 for adults, 2019 for adolescents (aged 12‑17 years), 2020 for children (aged 6-11 years), Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. DUPIXENT MyWay®. DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. 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. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. Copay Card or you wish to discontinue your participation, please contact us. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. 71 for Dupixent compared to 0. DUPIXENT MyWay® Program Taking Dupixent. At that point we will owe 20% of the cost of the medication, which adds up to just under $700/month. Monday-Friday, 8 am-9 pm ET. 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 1‑844‑DUPIXENT 1-844-387-4936. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. For assistance, please call 1-844-468-2252 Monday Friday, 8AM to 8PM ET. 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. 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 any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. Social Security income, unemployment insurance benefits, disability income, any other income for the household. 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 ALLERGISTSThe price you pay for Dupixent can vary. 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 ALLERGISTSyou are supposed to get a copay savings card from dupixent myway. A program called Dupixent MyWay is available for this drug. Dupixent on a High Deductible Health Plan. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. 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. I’m a registered nurse with DUPIXENT MyWay. 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. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. ) Please refer to Section 8, Patient Certifications, for. Do NOT shakeConoce las dos opciones de administración disponibles: jeringa precargada de 200 mg y 300 mg, y pluma precargada de 200 mg y 300 mg (para edades de 12 años o más), y revisa cómo inyectar DUPIXENT® (dupilumab), un medicamento para inyección subcutánea, de venta con receta, para el eczema moderado a grave en adultos y niños de 6 meses o más. SIGN UP TO SPEAK WITH A DUPIXENT MyWay ® MENTOR . Pay as little as $0 per month. If I am completing Section 5b, I authorize for my commercially insured patient one. With the DUPIXENT MyWay Copay Card, eligible,. I pay for it with my insurance and the myway copayment program. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm01. Type text, add images, blackout confidential details, add comments, highlights and more. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. If this is the case, write the preferred specialty pharmacy. 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. a Coverage varies by type and plan. Dupixent MyWay Program Dupixent (dupilumab injection). Browse the DUPIXENT® (dupilumab) sitemap to help you learn more about uncontrolled moderate- to-severe eczema in adults and children aged 6 months & older and navigate DUPIXENT. If you are moderate to low-income person with eczema or just need help paying for your health care or prescription costs, you’ve come to the right place. DUPIXENT was studied in adults and children 6 months of age and older. 00, but I do have some money invested. if speciality. . 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 otherBy checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. 98% of Commercially Insured Patients. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. Biologic Drug: Biologic drugs are made from living cells and are often expensive. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Governed and delivered by Service Canada. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 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. Does anyone know of any assistance programs I can use to help assist in the copay after dupixent my way limit is reached?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. 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. 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. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm 01. 22. Type text, add images, blackout confidential details, add comments, highlights and more. 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. Please see. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. For patients with commercial insurance who are new to DUPIXENT and experiencing a. Serious adverse reactions may. chevron_right. (The patient is lucky / unlucky enough to have an income that would rule out the Patient Assistance Program. 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. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Since MyWay covers 13,000 a year, that will count towards your deductible.