DUP. (2 of 3) Patient signature/Legal representative if patient is <18 years Date Section 2. 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. out and fax back to DUPIXENT MyWay at 1-844-387-9370 • You or your specialist can call 1-844-DUPIXEN(T), option 1 • Providing your email address allows DUPIXENT MyWay to give you more support resources about DUPIXENT. Especially tell your healthcare provider if you. At one point, I was getting cold sores every 2 to 3 weeks consistently. Dupixent (dupilamab) Dupixent MyWay patient support program. DUPIXENT® (dupilumab) is a prescription medicine used to treat people aged 6 years and older with moderate-to-severe atopic dermatitis (eczema) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Hear real patients stories of life with uncontrolled moderate-to-severe asthma and how discovering DUPIXENT® (dupilumab) impacted their journey. Serious side effects can occur. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. 4. Injection site reactions and eye conditions are the most common side effects reported and, unlike several other biologics, the risk of infection is low. The increase was approved by the Minnesota Legislature and will help expand SNAP eligibility to families who may have previously been ineligible for the. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notEnrollment 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. Some Medicare plans may help cover the cost of mail-order drugs. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit got Dupixent MyWay copay assistance and they never asked one question about my income. -The original form (from the first guy) was still in the system and the folks at MyWay were “confused” by it. 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. you offering to give them $170 they assumed you didn’t want to bother contacting dupixent myway. DUPIXENT is not a steroid or immunosuppressant; it is a prescription biologic medicine given under the skin (subcutaneous injection). 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). 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. 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. Lancet. I knocked out the first copay out of pocket and went on the manufacturer website and applied for the dupixent my way card. This copay card may be for you if you. I may opt out of receiving Communications, individual support services, including the DUPIXENT MyWay® Copay Card, or opt out of DUPIXENT MyWay® entirely at any time by notifying a representative by telephone at 1-800-633-1610 or by sending a letter to Sanofi US Customer Service P. if speciality. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. If you are a New York prescriber, please use an original New York State prescription form. You or your patients can contact DUPIXENT MyWay® at 1-844-DUPIXEN(T) (1-844-387-4936) 1-844-DUPIXEN(T) (1-844-387-4936) to learn more. 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 side effects. ago It is actually not a change in the myway program. comfysnail • 1 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. As far as choosing a better plan with a lower deductible, I don't really have much of a choice. Compare monoclonal antibodies. Pay as little as $0 per month. 23. Quantity Limits: Dupixent: 200 mg/1. 00 per injection. Access the dupixent reimbursement form either online or through your healthcare provider. a Coverage varies by type and plan. Prurigo Nodularis: The most common adverse reactions (incidence ≥2%) are nasopharyngitis, conjunctivitis, herpes infection, dizziness, myalgia, and diarrhea. 00 copay. 67 mL; 200 mg per 1. LEARN ABOUT OUR PATIENT SUPPORT PROGRAM. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm 01. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. We just need you to answer a few questions to verify your eligibility and contact information. The U. ( 1-844-387-4936 ), option 1. b New adult and pediatric patients aged 6 years and older with moderate-to-severeSection 5a. XXXX 00/0000 b y: A B C c o m pa n y, I n c. 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. Serious adverse reactions may. 02. 89 and -1. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. 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. THE DUPIXENT MyWay PROGRAM. 0156 Last Update: March 2023 DUP. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. DUPIXENT MyWay®. At one point, I was getting cold sores every 2 to 3 weeks consistently. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. 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. Household Income. b Data as of January 2023. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. Approval represents the second dermatology indication for Dupixent and fifth disease indication overall in the. 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). 1,000-125=875 $875 is the amount your health insurance pays. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. If you don't have insurance at all, the only realistic option is to qualify for income-based help from Dupixent directly. 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. The DUPIXENT MyWay program also provides useful tools and resources to help you stay on track with your treatment. I suppose it doesn't really matter now. 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). The specialty pharmacy is responsible for securing coverage on my patient’s behalf. chevron_right. 00. Find the safety profile, including most common side effects, of DUPIXENT® (dupilumab) for infant to preschoolers 6 months to 5 years of age with uncontrolled moderate-to-severe atopic dermatitis . ) I agree that Regeneron Pharmaceuticals, Inc. Pay as little as $0 per month. 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). 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. Financial criteria for patient assistance. Rx: DUPIXENT® (dupilumab) (100 mg/0. Patient Signature _____ If you have questions about the . Dupixent will run about $3000 per month with my insurance until my maximum is met. 01. Susie16 Oct 15, 2023 • 9:37 PM. And I would experience blurry vision, red and itchy eyes. Sign up or activate your card here. I've been on Dupixent for over 2 years now and it has been such a great experience keeping my eczema under control. Dupixent MyWay Program Dupixent (dupilumab injection). , chart notes, laboratory values) and use of claims history documenting the following: 1. Eczema. Fill a 90-Day Supply to Save. Call 1-844-387-4936 SUMIT COMPLETED PAGES 1 2 Fax: 1-844-387-9370 MF, 8am9pm ET Document Drop: (code: 8443879370) Patient Name DO / / Prescriber Name Prescriber AddressDupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 06 and -1. A program called Dupixent MyWay is available for this drug. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. If this is the case, write the preferred specialty pharmacy. The patient would prefer not to try. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. 0252 Last Update: Feb 2023 DUP. Program Website : Patient Assistance Applicationsfor DUPIXENT® dupilumab therapy My Information. 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. I also enrolled in the dupixent my way program and my ambassador told me that as long as you don’t make $100,000 a year you qualify for the program to get dupixent free for a year. 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). For patients with commercial insurance who are new to DUPIXENT and experiencing a. Over 80% of insurance plans cover Dupixent, but many have restrictions. He continued with Dupixent and his symptoms had partially improved 24 weeks after their onset. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. how to afford it then - it's been so helpful!! 3 Reactions. They pay the first $13K (in a year) then when that is exhausted I will have to pay around $250 per month and the $13K starts over in January 2019. 01. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. 34 milliliters 200 mg/1. 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. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. “It’s an incredible feeling to be validated and. They never mentioned only covering a. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. Dupixent MyWay Program CONTACT INFO: Address:, Phone: 1-844-387-4936: Provider Phone: Fax: 1-844-387-3970: Website: Program Website: ELIGIBILITY Eligibility Info:. DUPIXENT MyWay Ambassador. Since 2017, Dupixent has increased in price by 13%. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. will not conduct a benefits verification. Fill out sections 5a and 5b completely to determine patient eligibility. TEL: 844. I suppose it doesn't really matter now. Please see. 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. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Rx: DUPIXENT® (dupilumab) (100 mg/0. with household income, to qualify. Sanofi offers a Dupixent MyWay copay card to some patients with commercial insurance, but it has eligibility requirements and a yearly maximum of $13,000. DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 26 [95% CI: 0. To more financial assistance news, dial 1‑844‑DUPIXENT ( 1-844-387-4936), option 1 Monday-Friday, 8 am - 9 pm ESTPRESCRIBER TO FILL OUT Section 6a. For more information, dial 1‑844‑DUPIXENT 1-844-387-4936 Monday-Friday, 8 am-9 pm ET. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. . SIGN UP TO SPEAK WITH A DUPIXENT MyWay ® MENTOR . 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. Serious side effects can occur. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. DUPIXENT MyWay. DUPIXENT can be used with or without topical corticosteroids. S. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 01. DUPIXENT . 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. Regeneron and Sanofi are committed to helping patients in the U. I’ve been with DUPIXENT MyWay since the very beginning. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. There is currently no generic alternative to Dupixent. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. 14 mL; and 300 mg per 2 mL. 28. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit . 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). 2 pens of 300mg/2ml. 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. Governed and delivered by Service Canada. - Rachel, DUPIXENT Patient Mentor, living with asthma. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. It may be covered by your Medicare or insurance plan. Self-nominate to become DUPIXENT MyWay® Ambassador, and if selected, you may have opportunities to share your story and offer encouragement to patients and their family members. 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. 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. LH Patient View; data through June 16, 2023. I pay for it with my insurance and the myway copayment program. Since MyWay covers 13,000 a year, that will count towards your deductible. Income at or below: Not Published: Medical expenses can be deducted from reported income:. DUPIXENT can be used with or without topical corticosteroids. Get ongoing, personalized nursing support; help scheduling monthly prescription refills and deliveries; and in-home, in-office, or online supplemental injection training. 2017;5 (6):1519-1531. 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. Please see. 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. It may be covered by your Medicare or insurance plan. Dupixent MyWay ™ will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket costs. And, if you're eligible, you can sign up and receive your card today. Get your personalized discussion guide to help yourself have a productive conversation with your doctor & see if DUPIXENT® (dupilumab) for uncontrolled moderate-to-severe atopic dermatitis is right for you. 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. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Serious side effects can occur. Dupixent is indicated for the treatment of severe atopic dermatitis in patients aged 6 to 11Dupilumab. Get a Quick Start. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. Hear from DUPIXENT® (dupilumab) patients & caregivers of patients 6 years and older with uncontrolled moderate-to-severe atopic dermatitis & healthcare professionals who treat atopic dermatitis, download helpful resources & explore future events. 06 and -1. DUPIXENT® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. There is currently no generic alternative to Dupixent. 14 ml, 300 mg/2 ml: Asthma, atopic dermatitis: 3 syringes for the first 28 days. 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)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. 14 mL, or 300 mg/2 mL)The average cash price for a 30-day supply of Dupixent is $5,298. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. I'm "only" 61 now though on Dupixent MyWay copay help. Option 1- you have to meet your deductible without Dupixent myway. 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. So, let's just pretend the total cost is $1,000/month. S. 01. Fill out sections 5a and 5b completely to determine patient eligibility. 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 is indicated for the following type 2 inflammatory diseases:,Atopic Dermatitis,Adults and adolescents,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. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 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. 23. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Serious side effects can occur. Check the liquid in the prefilled pen or syringe. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. It took the price from 2K to 1K. Using the drop. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. 67 mL, 200 mg/1. It will also depend on how much you have. 23. Just got the fun news that I will need to pay $2,700 for a monthly dose of Dupixent. A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. Be sure to fill out your enrollment form completely and accurately. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Nationally are Covered for DUPIXENT. 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. 03. 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 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. 2 pens of 300mg/2ml. 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. I’m a registered nurse with DUPIXENT MyWay. Serious adverse reactions may occur. 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. Nurse Educators Nurse Educators offer one-on-one support to help patients start and stay on track with therapy. How many people live in your household? _____ Please refer to. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. Sanofi and Regeneron are committed to helping patients in the U. Fill a 90-Day Supply to Save. 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. Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. We are finding the Dupixent MyWay program to be quite challenging to understand; we don't know whether that might be an option, and we are looking at other options, even expensive ones. Serious side effects can occur. Dupixent MyWay pays the $500 copay. Sign it in a few clicks. 98% of Commercially Insured Patients. Please see Important Safety Information and Patient Information on. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. Find the safety profile, including most common side effects, of DUPIXENT® (dupilumab) for infant to preschoolers 6 months to 5 years of age with uncontrolled moderate-to-severe atopic dermatitis . QUEST (12+ years) DUPIXENT offers rapid breathing relief patients can feel as early as Week 2. including household income, to qualify. S. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT (maximum of $13,000 per patient per calendar. 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. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. 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. Learn why DUPIXENT® (dupilumab) may be an. There is another biologic very similar to Dupixent called Adbry. Section 5a. DUPIXENT MyWay® can assist with: Verifying patient’s specific health plan coverage for DUPIXENT; Determining utilization management (UM) criteria; Identifying patient’s possible out-of-pocket responsibilities; Helping navigate any required prior authorization (PA) processes; Educating you and your patient about the appeals process if. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. Opinions clash over private equity’s effect on dermatology. 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. In clinical trials, the impact of DUPIXENT on lung function was studied in patients 6 to 11 years of age and patients 12 years of age and older. Fax the Enrollment Form to DUPIXENT MyWay. When I was very young, I knew that I wanted to be a nurse. will need to meet the eligibility criteria, including household income, to qualify. 22. Base amount is $558. For more information, call 1. 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. dupixent myway income guidelinesstellaris unbidden and war in heaven. THE DUPIXENT MyWay PROGRAM. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. a FDA approved since 2017 for adults, 2019 for adolescents (aged 12‑17 years), 2020 for children (aged 6-11 years), and 2022 for infants to preschoolers (aged 6 months-5 years) with uncontrolled moderate‑to‑severe atopic dermatitis. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. Dedicated Dupixent MyWay Case Managers can explain information related to Dupixent. 03. The $500 payment counts towards the member’s deductible and out-of-pocket maximum. You don’t have to put your life on hold to fit your dosing schedule. 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. To contact DUPIXENT MyWay, please call 1-844-DUPIXENT (1-844-387-4936). What it is used for. If I am completing Section 5b, I authorize for my commercially insured patient one. Please see accompanying full Prescribing Information. Serious side effects can occur. Dupixent changed my life completely. 22. Serious side effects can occur. I have read and agree to the Income Verification included in Section 8 on page 5. For more information, please call 1-844-Dupixent (1-844-387-4936) or visit a personalized discussion guide to make the most of your doctor's visit whether you're beginning your EoE treatment journey or looking for another option. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. Dupixent is administered as an injection under the skin (subcutaneous injection) at different injection sites. Subcutaneous Solution 100 mg/0. 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. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Eligible patients will receive their cards by email. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. DUPIXENT MyWay ENROLLMENT FORMS; English Enrollment Form. 17 and 0. living with prurigo nodularis. There is currently no generic alternative to Dupixent. for DUPIXENT® dupilumab therapy My Information. DUPIXENT should not be stored above 77 °F (25 °C). 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. ) Please refer to Section 8, Patient Certifications, for. Hello! Switching insurance this year and need to prepare for increasing costs of dupixent with my new insurance. I’m Laurie. Over 80% of insurance plans cover Dupixent, but many have restrictions. For more information or to enroll in the patient support program, contact us at: 1‑844‑DUPIXENT 1-844-387-4936 Monday-Friday, 8 am-9 pm ET. 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. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. 12. With of DUPIXENT MyWay Copay Card, right, commercially insured patients might pay as little as $0* copay per fill of DUPIXENT. living with prurigo nodularis. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. Sign it in a few clicks. If I am completing Section 5b, I authorize for my commercially insured patient one. Applies to: Dupixent Number of uses: per prescription per year. Fill out sections 5a and 5b completely to determine patient eligibility. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help. Since 2017, Dupixent has increased in price by 13%. DUPIXENT is taken by injection under the skin (subcutaneous injection) once every two weeks. I'm guessing this will not be allowed once I'm on Medicare. ) Please refer to Section 8, Patient Certifications, for. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT (maximum of $13,000 per patient per calendar year) if they meet the eligibility requirements, including: Have commercial insurance, including health insurance exchanges, federal employee plans, or state employee plans 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 more. 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. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. LONG-LASTING CLEARER SKIN AT 16 and 52 Weeks 22% taking. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. 2022;400 (10356):908-919. 22. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. According to the manufacturers, Dupixent can be dosed to a maximum daily dose as indicated below.