Sign it in a few clicks. 0156 Last Update: March 2023 DUP. 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. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. Please see Important Safety Information and Prescribing Information and Patient Information on website. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. 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. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. I just started this week so I look forward to seeing the results. DUPIXENT MyWay®. 0252 Last Update: Feb 2023 DUP. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. Refrigerate it at 36 °F to 46 °F. 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. will not conduct a benefits verification. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. 01. Dupixent MyWay pays the $500 copay. dupixent myway income guidelinesstellaris unbidden and war in heaven. 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. how to afford it then - it's been so helpful!! 3 Reactions. Financial criteria for patient assistance. 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. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,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. Note: All information is required unless otherwise indicated. Dupixent will run about $3000 per month with my insurance until my maximum is met. Follow these tips to take DUPIXENT while traveling: Store DUPIXENT in the original carton to protect it from light. S. If patients become infected while receiving treatment with DUPIXENT and do not respond to anti-helminth treatment, discontinue treatment with DUPIXENT until the infection resolves. Dupixent on a High Deductible Health Plan. 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. It may be covered by your Medicare or insurance plan. 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. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. 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. I give supplemental injection training to the patient and the patient’s caregiver. Quantity Limits: Dupixent: 200 mg/1. Coverage varies by type and plan. Decreased exacerbations and/or improvement in symptoms 2. Financial criteria for patient assistance. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. 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. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. a,b a Data on file, Sanofi and Regeneron, US. • Store DUPIXENT in the original carton to protect from light. ) 2 Prescription InformationDUPIXENT is not a steroid. For more informational, page 1‑844‑DUPIXENT (1-844-387-4936), option. • Store DUPIXENT in the refrigerator at 36°F to 46°F (2°C to 8°C). 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). Dupixent is not intended for episodic use. • DUPIXENT can be stored at room temperature up to 77°F (25°C) up to 14 days. There is currently no generic alternative to Dupixent. 0156 Last Update: March 2023 DUP. For Healthcare Professionals. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. If you have any additional questions about this pricing information, please call DUPIXENT MyWay at 1-844-DUPIXENT (1-844-387-4936). Dupixent is not intended for episodic use. “Eczema otherwise unspecified” is not indicated for Dupixent. Eligible patients will receive their cards by email. Once you’ve been prescribed DUPIXENT, your healthcare provider can download the enrollment form, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370. 1kg to 18. Patient assistance program. 00. Patient has been compliant on Dupixent therapy 4. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. 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. 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. 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. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. Program has an annual maximum of $13,000. With and DUPIXENT MyWay Copay Card, eligible, commercially insured care may pay when little as $0* copay by fill the DUPIXENT. Over 80% of insurance plans cover Dupixent, but many have restrictions. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. “It’s an incredible feeling to be validated and. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to therapy whether they are uninsured, lack coverage, or need assistance with their out-of. If necessary, DUPIXENT may be kept at room temperature up to 77 °F (25 °C) for a maximum of 14 days. You can email or print the enrollment forms below. Assistance may be available for patients who do not have insurance. for DUPIXENT® dupilumab therapy My Information. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. comfysnail • 1 yr. 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. 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. 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. Fill out sections 5a and 5b completely to determine patient eligibility. I’m a registered nurse with DUPIXENT MyWay. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. 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. Find videos and downloadable instructions for the two injection administration options available for DUPIXENT® (dupilumab), pre-filled syringe (200 mg or 300 mg) with needle shield for ages 6 months & older, or pre-filled pen (200 mg or 300 mg) for ages 2+ years. Dupixent is indicated for the treatment of severe atopic dermatitis in patients aged 6 to 11Dupilumab. 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. DUPIXENT MyWay. Página de inicio de franquicias ; Eczema moderado a grave (6 meses de edad o más) Asma moderada a grave (6 años de edad o más) DUPIXENT Pricing Information For Healthcare Professionals. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. , chart notes, laboratory values) and use of claims history documenting the following: 1. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. . Fax the Enrollment Form to DUPIXENT MyWay. Some Medicare plans may help cover the cost of mail-order drugs. Patient is responsible for any out-of-pocket amounts that exceed the program limit. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. On dupixent, Dupilumab, I honestly felt I was in my 60 to 70s+ with joint pains throughout my entire body even into the smallest of joints like fingers. If I am completing Section 5b, I authorize for my commercially insured patient one. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. Monday-Friday, 8 am - 9 pm ET 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. You may be able to lower your total cost by filling a greater quantity at one time. There is currently no generic alternative to Dupixent. Monday-Friday, 8 am-9 pm ET. Access the dupixent reimbursement form either online or through your healthcare provider. Opinions clash over private equity’s effect on dermatology. Needed additional leadership equipped the enrollment process? Contact your section accessories dedicated or call DUPIXENT MyWay. 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. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 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. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. Program Website : Patient Assistance Applications for DUPIXENT® dupilumab therapy My Information. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. For more information, call 1. Applies to: Dupixent Number of uses: per prescription per year. Do not store DUPIXENT pre-filled syringes at room temperatures more than 77°F (25°C) Do not keep DUPIXENT at room temperature. Biologic Drug: Biologic drugs are made from living cells and are often expensive. ) 2 Prescription InformationDUPIXENT MYWAY ENROLLMENT FORM Moderate-to-Severe Atopic Dermatitis SUBMIT COMPLETED PAGES 1 & 2 Fax: 1-844-387-9370 Document Drop: (code: 8443879370) Patient Name DOB / / Prescriber Name Prescriber Address NPI # Prescriber State License # (Required in Puerto Rico only). Robocalls increase diabetic retinopathy screenings in low-income patients. 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. It should only be given by an adult caregiver in children 6 to 11 years of age. For more information, dial 1‑844‑DUPIXENT 1-844-387-4936 Monday-Friday, 8 am-9 pm ET. In SINUS-24 and SINUS-52, 74% fewer patients required SCS use at Week 52 with DUPIXENT 300 mg Q2W + INCS compared to placebo + INCS (HR: 0. J Allergy Clin Immunol Pract. -The original form (from the first guy) was still in the system and the folks at MyWay were “confused” by it. 0252 Last Update: Feb 2023 DUP. If you’re the spouse or. The fax number is 1. A case series of 12 people prescribed Dupixent reported an average weight gain of 6. 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. Maximum Monthly Gross Income. 71 for Dupixent compared to 0. Please complete the form, sign, and FA to 1-844-23-312. I give supplemental injection training to the patient and the patient’s caregiver. 1-844-DUPIXENT 1-844-387-4936. 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. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). A program called Dupixent MyWay is available for this drug. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. THIS IS NOT INSURANCE. 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. DUP. With MyWay, I get the year for free. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. I’m Laurie. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. 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. Share your form with others. Patient to Fill Out. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. - Rachel, DUPIXENT Patient Mentor, living with asthma. If you are a New York prescriber, please use an original New York State prescription form. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. 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). Learn how DUPIXENT helped treat children 6 to 11 years old with their moderate-to-severe asthma. 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® (dupilumab) is a. 09. 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). Please see Important Safety Information and full PI on website. DUPIXENT is not used to treat sudden breathing problems. 8K subscribers in the eczeMABs community. (The patient is lucky / unlucky enough to have an income that would rule out the Patient Assistance Program. Each time you fill your DUPIXENT prescription, please ensure your. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. 58 for 2. 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. Pay as little as $0 per month. Support. 0185 Last Update: November 2022 DUP. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. It still covers the same amount. And I would experience blurry vision, red and itchy eyes. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. And very recently got laid off due to Covid-19. 03. 03. 23. It took the price from 2K to 1K. the info from that copay savings card you will give to alliance and they process that after insurance (so the $170 copay they’d cover) which would leave you with $0 copay. Please see Important Safety Information and Prescribing Information and Patient Information on website. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Eligible patients will receive they cards by e-mail. you offering to give them $170 they assumed you didn’t want to bother contacting dupixent myway. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. Rx: DUPIXENT® (dupilumab) (100 mg/0. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. Please see accompanying full Prescribing Information. ago It is actually not a change in the myway program. 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. Household Size. When I was very young, I knew that I wanted to be a nurse. 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. The most common side effects include: DUPIXENT MyWay. Appears that my out of pocket maximum will be $8000 through insurance. a Coverage varies by type and plan. ®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. THE DUPIXENT MyWay PROGRAM. Serious adverse reactions may occur. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and. Fill out the form accurately and completely, providing all. 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. 14 ml, 300 mg/2 ml: Asthma, atopic dermatitis: 3 syringes for the first 28 days. Continuation in the DUPIXENT MyWay Patient Assistance Program is conditioned upon timely verification of income. These programs and tips can help make your prescription more affordable. 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. $0 is the amount you pay. Lancet. 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. 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 speciality. Dupixent MyWay Copay Card. I just spoke to someone through the MyWay Program. 03. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. Please see Important Safety Information and Patient Information on. 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. ®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. Continuation in the program is conditioned upon timely verification of income. Patients in each age group saw improved lung function in as little as 2 weeks. So, let's just pretend the total cost is $1,000/month. Support. Sign up for the DUPIXENT MyWay® mentor program for adults with uncontrolled chronic rhinosinusitis with nasal polyposis that is associated with type 2 inflammation. 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. 38]). Serious side effects can occur. PRESCRIBER TO FILL OUT Section 6a. It contains 300 mg of DUPIXENT for injection under the skin (subcutaneous injection). Have commercial insurance, including health insurance. 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. I pay for it with my insurance and the myway copayment program. 80). Serious adverse reactions may. Section 5a. XXXX 00/0000 b y: A B C c o m pa n y, I n c. Dupilumab. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. It's like $35k-$40k. It is not an immunosuppressant or a steroid. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. for DUPIXENT® dupilumab therapy My Information. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notOnce you’ve been prescribed DUPIXENT, your healthcare provider can download the enrollment form, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370. About 75,000 adults in the U. 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. These programs and tips can help make your prescription more affordable. 67 mL, 200 mg/1. When I was very young, I knew that I wanted to be a nurse. If I am completing Section 5b, I authorize for my commercially insured patient one. 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. 00. 00, but I do have some money invested. Injection Support Center Injection Reminders and Tips FREQUENTLY ASKED QUESTIONS; Español. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. 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. 67 mL, 200 mg/1. DUPIXENT® (dupilumab) is taken as an injection by a pre-filled syringe or pre-filled pen. 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. 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. The increase was approved by the Minnesota Legislature and will help expand SNAP eligibility to families who may have previously been ineligible for the. 06 and -1. Learn why DUPIXENT® (dupilumab) may be an. For pediatric patients aged 6 to 11 years, Dupixent dosing is based on weight (100 mg every two weeks or 300 mg every four weeks for children ≥15 to <30 kg, and 200 mg every two weeks for children ≥30 kg) and is supplied as a pre-filled syringe. Required if enrolling in the DUPIXENT MyWay. . for DUPIXENT® dupilumab therapy My Information. DUPIXENT can cause serious side effects, including: The most common side effects in patients with eczema include. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. 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. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. QUEST (12+ years) DUPIXENT offers rapid breathing relief patients can feel as early as Week 2. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. I’ve been with DUPIXENT MyWay since the very beginning. (2 of 3) Patient signature/Legal representative if patient is <18 years Date Section 2. $125 is the amount Dupixent assistance pays. Fill out sections 5a and 5b completely to determine patient eligibility. 0129 Last Update:. At that point we will owe 20% of the cost of the medication, which adds up to just under $700/month. Ready to connect with actual patients and caregivers being treated with DUPIXENT? The DUPIXENT MyWay Mentor Program helps put current and prospective moderate-to-severe eczema (atopic dermatitis or AD) DUPIXENT patients in contact with people going through similar. 1-844-DUPIXENT 1-844-387-4936. 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. 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. Income at or below: Not Published: Medical expenses can be. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. United Healthcare covers it but I get insurance through my employer and it was a huge pain to get approved. For more information, dial 1. For more information, call 1-844-DUPIXENT. You may be able to lower your total cost by filling a greater quantity at one time. 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. 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). Hello! Switching insurance this year and need to prepare for increasing costs of dupixent with my new insurance. Coverage varies by. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. 23. 67 mL, 200 mg/1. 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. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. 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. 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. I also have the dupixent myway card that covers a total of $13,000 for the year. Rx: DUPIXENT® (dupilumab) (100 mg/0. 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. store above 77 °F (25 °C). If you are a New York prescriber, please use an original New York State prescription form. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit . 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. Serious side effects can occur. 5. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. - Rachel, DUPIXENT Patient Mentor, living with asthma. This DUPIXENT Pre-filled Pen is a single-dose device. 17 and 0. 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. Household Income. Also, make sure to store the DUPIXENT MyWay phone number in your phone’s contacts so you. The $500 payment counts towards the member’s deductible and out-of-pocket maximum. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. DUPIXENT should not be stored above 77 °F (25 °C). Using the drop. 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. The average cash price for a 30-day supply of Dupixent is $5,298. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. chevron_right. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. 2022;400 (10356):908-919. Check the liquid in the prefilled pen or syringe. 5011 XXX X < M A T > 00000 0 300 mg/ 2 m L Look at theFull Prescribing Information: Patient Information: Learn more about DUPIXENT: Thanks for c. Compare . with household income, to qualify. Sign it in a few clicks. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. DUPIXENT (dupilumab) Dupixent FEP Clinical Criteria AND submission of medical records (e. 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. financial assistance for eligible patients, provide one-on-one nursing support, and more. This copay card may be for you if you. S. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. Also if your insurance does cover,Dupixent offers a co-pay card that. The formulary status tool below can help check DUPIXENT coverage for various plans. 14 mL, or 300 mg/2 mL)I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Data from DUPIXENT ® clinical trials have shown that IL-4 and IL-13 are key drivers of the type 2 inflammation that plays a major role in asthma, atopic. Advertisement. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. A program called Dupixent MyWay is available for this drug. 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. 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. Since 2017, Dupixent has increased in price by 13%. 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). Section 5a. I found the carnivore diet helps immensely for autoimmune issues. For patients with commercial insurance who are new to DUPIXENT and experiencing a. 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. 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. 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. Monday-Friday, 8 am-9 pm ET. living with prurigo nodularis are most in need of new treatment options . 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. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Caring.