Tell your healthcare provider if you have any side effect that bothers you or that does not go away. PDF Enrollment Form 1-844-387-9370 Document Drop at www.patientsupportnow Patients will need to meet the eligibility criteria, including household income, to qualify. Dupixent MyWay Program Dupixent (dupilumab injection) Last Updated: 03/09/2023 Application Forms & Instructions The following documents are provided in interactive PDF format, allowing you to type information directly into the form. phenotype or with oral CONTRAINDICATION: DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients. team can research each patient's situation and determine eligibility. DUPIXENT MyWay 2023Sanofi and Regeneron Pharmaceuticals, Inc. All Rights Reserved. to treat adults and children 6 months of age and older with moderate-to-severe eczema (atopic dermatitis or AD) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. with other asthma medicines for the maintenance treatment of moderate-to-severe eosinophilic or oral steroid dependent asthma in adults and children 6 years of age and older whose asthma is not controlled with their current asthma medicines. It is not known whether DUPIXENT passes into your breast milk. Program has an annual maximum of $13,000. If you are a New York prescriber, please use an original New York State prescription form. DUP.23.01.0314 Last Update: March 2023, DUP.22.11.0007 Last Update: December 2022, DUP.23.01.0070 Last Update: February 2023, DUP.22.10.0421 Last Update: February 2023, DUP.22.03.0291 Last Update: July 2022, DUP.22.05.0386 Last Update: September 2022, Moderate-to-Severe Eczema (Ages 6+ Months), Moderate-to-Severe Asthma (Ages 6+ Years), Chronic Rhinosinusitis with Nasal Polyposis, Uncontrolled moderate-to-severe eosinophilic or, https://mothertobaby.org/ongoing-study/dupixent/, Conduct virtual or over-the-phone training, How-to supplemental injection training videos, Tips to help manage feelings of uncertainty, Have effective conversations with your healthcare provider, Learn about programs that may help cover the cost of DUPIXENT. Pricing and Insurance | DUPIXENT (dupilumab) The NeedyMeds Drug Discount Card; . Your email is on its way. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Each of these phases has different cost-sharing amounts. DUPIXENT can be used with or without topical corticosteroids. Please note: By clicking on this link, you will be leaving this Sanofi-hosted US website and going to another, entirely independent website. The prior authorization information required by the patients insurance to approve coverage for DUPIXENT may include the patients history, medication, and clinical information. This price guide is based on using the Drugs.com discount card which is accepted at most U.S. pharmacies. 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 by an eosinophilic phenotype or with oral corticosteroid dependent asthma. Your doctor may still need to provide more documentation. These are not all the possible side effects of DUPIXENT. This program is not valid where prohibited by law, taxed or restricted. Maternal IgG is known to be present in human milk. I dont really get scared anymore. to contact Regeneron Pharmaceuticals, Inc. 202333322 Sanofi and Regeneron Pharmaceuticals, Inc. All Rights Reserved. Ive been withDUPIXENT MyWaysince the very beginning. Atopic Dermatitis: Your email is on its way. established. You or your doctor can download the enrollment form on DUPIXENT.com or call 1-844-DUPIXENT, Option 1 to enroll. The DUPIXENT MyWayPatient Assistance Program may be able to help. It is not known if DUPIXENT is safe and effective in children with asthma under 6 years of age. Patients should seek medical advice if their asthma remains uncontrolled or worsens after initiation of DUPIXENT. Before using DUPIXENT, tell your healthcare provider about all your medical conditions, including if you: are scheduled to receive any vaccinations. With the Copay Card, You Could Pay as Little as $0 . Not only to teach them how to give themselves the medicine, but also to just come and give them encouragement, and show them kindness and patience. Health insurance coverage in the United States: 2016. The list price* of DUPIXENT is $3,587.92 USD per carton, but most people will not pay the list price. o A pregnancy registry for women who take DUPIXENT during pregnancy collects information about the health of you and your baby. is a patient support program This is typical for a specialty drug like DUPIXENT, and It is not known whether DUPIXENT passes into your breast milk. PATIENT SUPPORT *48 Contiguous States and District of Columbia Source: US Dept of Health & Human Services. Important Safety Information. Please note: By clicking on this link, you will be leaving this Sanofi-hosted US website and going to another, entirely independent website. Acute Asthma Symptoms or Deteriorating Disease: Do not use DUPIXENT to treat acute asthma symptoms, acute exacerbations, acute bronchospasm or status asthmaticus. Limitation of Use: DUPIXENT is not indicated for the relief of acute bronchospasm or status asthmaticus. And while everyones working through the details, look toDUPIXENT MyWayfor additional support. I make sure that I gather all of the things that I may need to help the experienced person, and then the person thats never even touched a needle. Especially tell your healthcare provider if you are taking oral, topical or inhaled corticosteroid medicines or if you have atopic dermatitis and asthma and use an asthma medicine. To enroll or get more information call 1-877-311-8972 or go to https://mothertobaby.org/ongoing-study/dupixent/. Patients prescribed DUPIXENT and enrolled inDUPIXENT MyWaycan access: Supplemental injection training in person, virtually, or by phone, Help scheduling deliveries of your prescription, Insightful tips and tools to help you along the way. Some people with Medicare Part D coverage are eligible for the Social Security Administration's Extra Help 4 program (also known as the Low-Income Subsidy or "LIS"), and they typically pay $3-$9 for their prescriptions. Our nurses work remotely from our homes. In those situations, the program may change its terms. For families/households with more than 8 persons, add $5,140 for each additional person. Whether youre considering treatment with DUPIXENT or youre a DUPIXENT patient or caregiver, you can sign up for emails and additional resources from DUPIXENT MyWay that can help you: Uncontrolled moderate-to-severe eosinophilic or oral steroid dependent asthma, Uncontrolled chronic rhinosinusitis with nasal polyposis. enrollment process, offer Income: Not disclosed: Diagnosis/Medical Criteria: FDA-approved diagnosis: A pregnancy registry for women who take DUPIXENT during pregnancy collects information about the health of you and your baby. DUPIXENT andDUPIXENT MyWayare registered trademarks of Sanofi Biotechnology. Some patients reported visual disturbances (e.g., blurred vision) associated with conjunctivitis or keratitis. Sanofi US is hosting this website on behalf of Sanofi and Regeneron Pharmaceuticals, Inc. Advise patients to report new onset or worsening joint symptoms. All Rights Reserved. Mail: DUPIXENT MyWay Copay Reimbursement Program, 200 Jefferson Park, Whippany, NJ 07981 Fax: 1-908-809-6249 I, _____, certify that the information provided for this reimbursement request is accurate to the best of my knowledge, and the product-specific copay, DUPIXENT is a prescription medicine used: Questions or comments? Prurigo Nodularis: 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. YETUNDE: The program is intended to help patients afford DUPIXENT. Please refer to Regeneron's Privacy Noticeand Sanofi'sPrivacy Policyfor more information regarding processing of your personal data. Current population reports. Your email is on its way. 8 am, Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP), Patient Access And reminding them that the specialty pharmacy may call them from an unknown number. RxAssist - Sanofi and Regeneron Pharmaceuticals, Inc. - Dupixent MyWay Please refer to Regeneron's Privacy Noticeand Sanofi'sPrivacy Policy for more information regarding processing of your personal data. What if when you leave, I dont know what to do and its time for me to give myself my injection again? I can refer the patient to the DUPIXENT website for more resources, and theres also a Nurse Educator phone number. Additional terms and conditions apply. THIS IS NOT INSURANCE. to a Losing Dupixent Due to Changes in MyWay Program : r/eczeMABs - Reddit I really enjoy the patient interaction. Your insurance company will work with your doctor to get any additional medical information they need. Healthcare providers should be alert to vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients with eosinophilia. Conjunctivitis also occurred more frequently in chronic rhinosinusitis with nasal polyposis subjects and prurigo nodularis subjects who received DUPIXENT compared to those who received placebo. are pregnant or plan to become pregnant. to treat adults and children 6 months of age and older with moderate-to-severe eczema (atopic dermatitis or AD) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP): DUPIXENT is indicated as an add-on maintenance treatment in adult patients with inadequately controlled CRSwNP. Ests a punto de abandonar este sitio para visitar nuestro sitio en ingls. Many specialty medications, such as DUPIXENT, have longer turnaround times because of the prior authorization process. Some people who use DUPIXENT have had trouble walking or moving due to their joint symptoms, and in some cases needed to be hospitalized. They have set aside this time for us to learn. It is not known if DUPIXENT is safe and effective in children with asthma under 6 years of age. DUPIXENT MyWay Support for Patients | DUPIXENT (dupilumab) YETUNDE: We have the ability to send out package inserts that include all the important safety information for DUPIXENT. Visit our Pricing and Insurance page to get more information on coverage, ordering through a specialty pharmacy, or cost. Advise patients to report new onset or worsening joint symptoms. Barnett JC, Berchick ER. If you do not have insurance that covers your prescription medications, or if your insurance does not DUPIXENT helps prevent severe asthma attacks (exacerbations) and can improve your breathing. Consider ophthalmological examination for patients who develop conjunctivitis that does not resolve following standard treatment or signs and symptoms suggestive of keratitis, as appropriate. Uncontrolled moderate-to-severe eosinophilic or oral steroid dependent asthma, Uncontrolled chronic rhinosinusitis with nasal polyposis, For more information or to enroll in the patient support program, dial 1844DUPIXENT(1-844-387-4936), Contact, Powered by Managed Markets Insight & Technology, LLC. You are encouraged to report negative side effects of prescription drugs to the FDA. DUPIXENT can cause serious side effects, including: Allergic reactions. are scheduled to receive any vaccinations. Acute Asthma Symptoms or Deteriorating Disease: Do not use DUPIXENT to treat acute asthma symptoms, acute exacerbations, acute bronchospasm or status asthmaticus. mechanism of dupilumab action I travel to see the patientssometimes for hours. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. Vaccinations: Consider completing all age-appropriate vaccinations as recommended by current immunization guidelines prior to initiating DUPIXENT. Dupixent Patient Assistance Program Cost for Low/Medium Income/WA State Tell your healthcare provider about any new or worsening joint symptoms. Learn how to get your patients started with DUPIXENT MyWay. working with specialty pharmacies to get dupixent. Any savings provided by the program may vary depending on patients' out-of-pocket costs. 1844DUPIXENT (1-844-387-4936), option 1. If you have any other questions, DUPIXENT MyWay can help you understand the process. Key points of contact for coverage are located on the card itself. to treat adults and children 12 years of age and older, who weigh at least 88 pounds (40 kg), with eosinophilic esophagitis (EoE). DUPIXENT (dupilumab) for Moderate-to-Severe Eczema that is Uncontrolled Help Heal Your Skin From Within DUPIXENT treats adults and children 6 months of age and older with moderate-to-severe eczema that is not well controlled with topical prescription therapies. Support, LEARN ABOUT OUR After a healthcare provider prescribes DUPIXENT, the patient schedules their delivery of DUPIXENT from the specialty pharmacy, pays the copay, coordinates the shipment, and can administer DUPIXENT themselves or receive the injection from a caregiver after appropriate training from their healthcare provider. Eosinophilic Esophagitis: DUPIXENT is indicated for the treatment of adult and pediatric patients aged 12 years and older, weighing at least 40 kg, with eosinophilic esophagitis (EoE). You are encouraged to report negative side effects of prescription drugs to the FDA. For more information, dial 1-844-DUPIXENT Please visit our Medications Available page to see if assistance is available for medication, Patient Assistance Connection Financial Eligibility. Advise patients to report new onset or worsening eye symptoms to their healthcare provider. Available at https://aspe.hhs.gov/poverty-guidelines. I give supplemental injection training to the patient and the patients caregiver. It is recommended to speak with your insurance provider for any outstanding questions you may have about the cost or dispensing of DUPIXENT because they know the full details of your plan. Sanofi US is hosting this website on behalf of Sanofi and Regeneron Pharmaceuticals, Inc. Sanofi and Regeneron are industry partners, who are committed to handling personal data in ways that respect your privacy. You are encouraged to report negative side effects of prescription drugs to the FDA. To enroll or get more information call. 2023Sanofi and Regeneron Pharmaceuticals, Inc. All Rights Reserved. to treat adults and children 12 years of age and older, who weigh at least 88 pounds (40 kg), with eosinophilic esophagitis (EoE). When our patients call in, they get to speak to a real person, an experienced clinician who can provide them support along their journey. Contact 1-844-DUPIXENT (1-844-387-4936) to speak to a DUPIXENT MyWay Nurse Educator if you have additional questions. Use DUPIXENT exactly as prescribed by your healthcare provider. Sometimes they can just take a deep breath, well go slow, think about their favorite place, think about something that reminds them and makes them happy and calms them down. As a reminder, with all of these folks helping to get you off to good start with DUPIXENT, you may receive phone calls from your doctors office, specialty pharmacy, and aDUPIXENT MyWayNurse Educator. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. Lastly, the specialty pharmacy reviews the prescription and contacts the patient to arrange for payment and delivery. I see the injection as something that I just have to do, and it doesnt freak me out as much as it did in the beginning. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. In the case of a denial, you may consider writing an appeal, if appropriate, making sure to address the plans specific concerns. It is not known if DUPIXENT is safe and effective in children with eosinophilic esophagitis under 12 years of age and who weigh at least 88 pounds (40 kg). See the program details. It is not known if DUPIXENT is safe and effective in children with atopic dermatitis under 6 months of age. Database current as of, https://www.ssa.gov/benefits/medicare/prescriptionhelp.html, https://www.cms.gov/files/document/2022-announcement.pdf, https://marketplace.cms.gov/technical-assistance-resources/fast-facts-medicaid-chip.pdf, DUP.23.01.0314 Last Update: March 2023, DUP.22.11.0007 Last Update: December 2022, DUP.23.01.0070 Last Update: February 2023, DUP.22.03.0194 Last Update: August 2022, DUP.22.03.0291 Last Update: July 2022, DUP.22.05.0386 Last Update: September 2022, Moderate-to-Severe Eczema (Ages 6+ Months), Moderate-to-Severe Asthma (Ages 6+ Years), Chronic Rhinosinusitis with Nasal Polyposis, Uncontrolled moderate-to-severe eosinophilic or oral steroid, https://mothertobaby.org/ongoing-study/dupixent/, https://www.census.gov/content/dam/census/library/publications/2017/demo/p60-260.pdf, https://www.bcbsm.com/index/health-insurance-help/faqs/plan-types/health-spending-accounts/fsa.html, Whether you have prescription drug insurance, Whether your insurance provider considers the medication to be preferred or not preferred. There are several reasons for this, including incomplete documentation, administrative errors, clinical reasons or a no-coverage determination, or a plan exclusion. Please be aware that not all Sanofi products are covered under the Sanofi Patient Assistance program. Stop using DUPIXENT and tell your healthcare provider or get emergency help right away if you get any of the following signs or symptoms: breathing problems or wheezing, swelling of the face, lips, mouth, tongue, or throat, fainting, dizziness, feeling lightheaded, fast pulse, fever, hives, joint pain, general ill feeling, itching, skin rash, swollen lymph nodes, nausea or vomiting, or cramps in your stomach-area. DUPIXENT MyWay will also remind the healthcare professional when the authorization is up for reapproval. Approval is not guaranteed. Im the one that cringes with needles, but she does great. Years, Weighing at DUPIXENT MyWay Portal are breastfeeding or plan to breastfeed. characterized by an eosinophilic DUPIXENT MyWay at 1-844-DUPIXEN(T) Limitation of Use: DUPIXENT is not indicated for the relief of acute bronchospasm or status asthmaticus. Voice-over (VO): For more information, Remember to quickly respond to these calls to avoid delays in receiving DUPIXENT. that can help with the Laurie:Im Laurie. Enter your email address and we will send you your requested resource. In children 6 months to less than 12 years of age, DUPIXENT should be given by a caregiver. Call your doctor for medical advice about side effects. If you have any other questions about these policies DUPIXENT MyWay can help you understand the process. Hypersensitivity: Hypersensitivity reactions, including anaphylaxis, serum sickness or serum sickness-like reactions, angioedema, generalized urticaria, rash, erythema nodosum, and erythema multiforme have been reported. Patient Support for Dupixent (dupilumab) injection - Sanofi U.S. Click the "CONTINUE" button below to go to the page you requested, or the "CANCEL" button to return to the previous page. Risk Associated with Abrupt Reduction of Corticosteroid Dosage: Do not discontinue systemic, topical, or inhaled corticosteroids abruptly upon initiation of DUPIXENT. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. A monthly supply of DUPIXENT (300 mg, 200 mg, or 100 mg) is defined as 2 injections per month. That also means you can expect the process for getting your prescription filled to be different from other medicines you may pick up from your local pharmacy. Prurigo Nodularis: DUPIXENT is indicated for the treatment of adult patients with prurigo nodularis (PN). This information is intended for U.S. Healthcare Professionals. For Patients Ages 6+ Contact your Field Access Specialist or call DUPIXENT MyWay at 1-844-387-4936, Monday through Friday, 8 am to 9 pm Eastern Time. Enter the insured patients ZIP Code below. Payments are averaged across all phases of Medicare coverage, and include coverage gap and catastrophic phase payments. When I was very young, I knew that I wanted to be a nurse. A causal association between DUPIXENT and these conditions has not been established. older, weighing at least 40 kg, with DUPIXENT MyWay is a patient support program that can help with the enrollment process, offer financial assistance for eligible patients, provide one-on-one nursing support, and more. are scheduled to receive any vaccinations. If you have enrolled inDUPIXENT MyWay, you will receive a welcome call from a nurse educator while your insurance benefits are being confirmed. Sanofi US and Regeneron provide these links as a service to their website visitors and users; however, they take no responsibility for the information on any website but their own. It is not known whether DUPIXENT will harm your unborn baby. DUPIXENT andDUPIXENT MyWay are registered trademarks of Sanofi Biotechnology. Some people who use DUPIXENT have had trouble walking or moving due to their joint symptoms, and in some cases needed to be hospitalized. Least 40 kg. Once DUPIXENT is approved, a specialty pharmacy may work with you to schedule shipments of DUPIXENT to your home or preferred location. DUPIXENT MyWay Patient Support Program . prescription therapies or when those Parasitic (Helminth) Infections: It is unknown if DUPIXENT will influence the immune response against helminth infections. DUPIXENT can be used with or without topical corticosteroids. Your email is on its way. financial assistance to eligible patients, one-on-one nursing support, and more. DUPIXENT is not used to treat sudden breathing problems. It is not known if DUPIXENT is safe and effective in children with eosinophilic esophagitis under 12 years of age and who weigh at least 88 pounds (40 kg). estimate my income in conjunction with the Patient Assistance Program eligibility determination process, if . Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. Does my insurance cover DUPIXENT (dupilumab)? with eosinophilic esophagitis Dupixent is the only thing that has given me true relief from eczema my entire life (mid-30s), quitting isn't something I want . Once final approval and payment are received, the patient coordinates shipment to their home or their healthcare providers office, depending on treatment plan. You should not receive a live vaccine right before and during treatment with DUPIXENT. A Summary of Benefits Form will be faxed to your office within a few days, detailing the patients coverageincluding prior authorization requirements and out-of-pocket costs. Tell your healthcare provider if you have any side effect that bothers you or that does not go away. How much is Dupixent without insurance? - singlecare.com Dupixent without insurance costs $4910 per 2, 2mL of 300 mg/2 mL prefilled syringe, or $3310 per month for 2, 2 mL of 300 mg/2 mL prefilled syringe. Patient Assistance Program may be able to help. 300 mg Pre-filled Pens are The most common side effects in patients with eczema include injection site reactions, eye and eyelid inflammation, including redness, swelling, and itching, sometimes with blurred vision, cold sores in your mouth or on your lips, and high count of a certain white blood cell (eosinophilia). Questions or comments? Patients should seek medical advice if their asthma remains uncontrolled or worsens after initiation of DUPIXENT. PDF 1 Enrollment Form moderate-to-severe asthma Learn how to get your patients started with DUPIXENT MyWay. o A pregnancy registry for women who take DUPIXENT during pregnancy collects information about the health of you and your baby.