0185 Last Update: November 2022 DUP. you offering to give them $170 they assumed you didn’t want to bother contacting dupixent myway. Additionally, Dupixent MyWay ™ offers personalized support from registered nurses and other specialists who are available 24/7 to speak with patients and help them navigate the complex insurance. 4. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Appears that my out of pocket maximum will be $8000 through insurance. Form more information phone: 844-387-4936 or Visit website Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. Caring. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. Continuation in the program is conditioned upon timely verification of income. What it is used for. 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 COPAY CARD. Dupixent MyWay Program Dupixent (dupilumab injection). 2 Eligible US residents with an FDA-approved. a ®® ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm600 mg (two 300 mg injections) 300 mg Q4W : 30 to less than 60 kg ; 400 mg (two 200 mg injections) 200 mg Q2W : 60 kg or more : 600 mg (two 300 mg injections)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. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. DUPIXENT® (dupilumab) is a. Tips. DUPIXENT® (dupilumab) is a. A case series of 12 people prescribed Dupixent reported an average weight gain of 6. DUPIXENT® (dupilumab) is taken as an injection by a pre-filled syringe or pre-filled pen. Griffinej5 • 2 yr. 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. Fill out sections 5a and 5b completely to determine patient eligibility. Declining androgen levels correlated with increased frailty. Nurse Educators Nurse Educators offer one-on-one support to help patients start and stay on track with therapy. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. How many people live in your household? _____ Please refer to. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. See All. Partner with a specialist near you to see if DUPIXENT® (dupilumab) is an option for you for uncontrolled moderate-to-severe eczema in adults and children aged 6 months & older. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T)(1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. Dupixent 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. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. 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. Have commercial insurance, including health insurance. Insurance Information Insurance? Yes No If yes, is it Medicare Part D? Primary insurance name Secondary insurance nameDupixent myway income limits 2022; where to buy authentic kf94 masks;. I’m Laurie. 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. DUPIXENT® is indicated as an add-on maintenance treatment of adult and pediatric patients 6 years and older with moderate-to-severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid. 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. The average cash price for a 30-day supply of Dupixent is $5,298. Serious adverse reactions may occur. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. Maybe try that while waiting for the Dupixent. 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. 06 and -1. This copay card may be for you if you. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. DUPIXENT (dupilumab) Dupixent FEP Clinical Criteria AND submission of medical records (e. VO: DUPIXENT is a prescription medicine used: to treat people aged 6 years and older with moderate-to-severe atopic dermatitis (eczema) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. If you don’t have health insurance, talk. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. I knocked out the first copay out of pocket and went on the manufacturer website and applied for the dupixent my way card. 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). 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. You may be able to lower your total cost by filling a greater quantity at one time. Nationally are Covered for DUPIXENT. It still covers the same amount. 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. You may be able to lower your total cost by filling a greater quantity at one time. We just need you to answer a few questions to verify your eligibility and contact information. Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm ET Enrollment FormYes, it does appear that Dupixent can cause weight gain, although this is not listed as a side effect in the product information. Select Condition Indication Moderate-to-Severe Eczema (Ages 6+ Months) Moderate-to-Severe Asthma (Ages 6+ Years) Chronic Rhinosinusitis with Nasal Polyposis (Ages 18+. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. Assistance may be available for patients who do not have insurance. Normally my copay would be about $970 per refill, but with about 12 refills per year this does not max out the Dupixent MyWay copay card. Copay Card or you wish to discontinue your participation, please contact us. If I am completing Section 5b, I authorize for my commercially insured patient one. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. I have read and agree to the Income Verification included in Section 8 on page 5. 0185 Last Update: November 2022 DUP. Dupixent is not intended for episodic use. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on1-844-DUPIXENT 1-844-387-4936. Also, make sure to store the DUPIXENT MyWay phone number in your phone’s contacts so you. Section 5a. Share your form with others. The formulary status tool below can help check DUPIXENT coverage for various plans. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. 28. 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). ( 1-844-387-4936 ), option 1. how to afford it then - it's been so helpful!! 3 Reactions. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Section 5a. b New adult and pediatric patients aged 6 years and older with moderate-to-severeSection 5a. 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. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. 98% of Commercially Insured Patients. for DUPIXENT® dupilumab therapy My Information. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. Rx: DUPIXENT® (dupilumab) (100 mg/0. Fax the Enrollment Form to DUPIXENT MyWay. Some Medicare plans may help cover the cost of mail-order drugs. Access the dupixent reimbursement form either online or through your healthcare provider. A program called Dupixent MyWay is available for this drug. Lancet. The doctor's office called to say I need to call to talk about my income and expenses. 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. Pay as little as $0 per month. Serious side effects can occur. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. , Sanofi US, and their affiliates and agents (together, the “Alliance”) may verifyDUPIXENT MyWay Nurse Educators are trained to help provide patients with supplemental injection training either online, over the phone, or in person with a training kit and practice syringe or practice pen. Depends if your insurance cares that Dupixent myway is paying your deductible. PRESCRIBER TO FILL OUT Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) Complete the entire form and submit pages 1-3 to DUPIXENT MyWay® via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm ET Enrollment Form FOR ALLERGISTS Using a mail-order specialty pharmacy might help lower the monthly cost of Dupixent. DUPIXENT can cause serious side effects, including: The most common side effects in patients with eczema include. 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. That is what I am in the middle of. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. 67 mL Dupixent subcutaneous solution from $3,787. 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. 1-844-DUPIXENT 1-844-387-4936. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. If you are a New York prescriber, please use an original New York. The formulary status tool below can help check DUPIXENT coverage for various plans. 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. 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. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. With the DUPIXENT MyWay Copay Card, eligible,. The DUPIXENT MyWay team can research each patient’s situation and determine eligibility. , 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. for DUPIXENT® dupilumab therapy My Information. You can email or print the enrollment forms below. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. 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. Continuation in the DUPIXENT MyWay Patient Assistance Program is conditioned upon timely verification of income. 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. Fill out sections 5a and 5b completely to determine patient eligibility. Patient assistance program. any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. (The patient is lucky / unlucky enough to have an income that would rule out the Patient Assistance Program. There is currently no generic alternative to Dupixent. financial assistance for eligible patients, provide one-on-one nursing. Browse the DUPIXENT® (dupilumab) sitemap to help you learn more about eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg) and navigate DUPIXENT. (DUPIXENT + Topical Corticosteroids (TCS) vs TCS only): CLEAR OR ALMOST CLEAR SKIN AT 16 Weeks 39% taking DUPIXENT + TCS vs 12% using TCS only. 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. DUPIXENT MyWay® is a patient support program designed to help you get access to DUPIXENT and help eligible patients cover the out-of-pocket costs of DUPIXENT. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. Dupixent may cause serious side effects. It may be covered by your Medicare or insurance plan. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. With of DUPIXENT MyWay Copay Card, right, commercially insured patients might pay as little as $0* copay per fill of DUPIXENT. 0252 Last Update: Feb 2023 DUP. THE DUPIXENT MyWay PROGRAM. Biologic Drug: Biologic drugs are made from living cells and are often expensive. Manufacturer Coupon. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. . Dupixent changed my life completely. Learn how DUPIXENT helped treat children 6 to 11 years old with their moderate-to-severe asthma. Dupixent on a High Deductible Health Plan. 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). To contact DUPIXENT MyWay, please call 1-844-DUPIXENT (1-844-387-4936). 14 mL, or 300 mg/2 mL)My insurance provider covers 85% and our Canadian version of 'MyWay' pays the remainder. 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. Children treated with Dupixent and topical corticosteroids (TCS) achieved clearer skin, experienced significantly improved overall disease severity and significantly reduced itch compared to TCS. J Allergy Clin Immunol Pract. THE DUPIXENT MyWay PROGRAM. DUPIXENT® (dupilumab) Prescription Information Quick Start may be able to provide DUPIXENT at no cost to help bridge patients to therapy if there is a coverage delay. 2022;400 (10356):908-919. Patient is responsible for any out-of-pocket amounts that exceed the program limit. So the nurse told me to fax receipts for year to date prescriptions and last year's income forms (W2, 1099, etc). Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. If I am completing Section 5b, I authorize for my commercially insured patient one. March 29, 2018. ) Please refer to Section 8, Patient Certifications, for. 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). 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). Patients in each age group saw improved lung function in as little as 2 weeks. A program called Dupixent MyWay is available for this drug. It was granted and I pay $0. Sign up or activate your card here. The most common side effects include: DUPIXENT MyWay. If I am completing Section 5b, I authorize for my commercially insured patient one. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. Fill a 90-Day Supply to Save. for DUPIXENT® dupilumab therapy My Information. 01. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. Regeneron and Sanofi are committed to helping patients in the U. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. DUPIXENT ® is a fully human monoclonal antibody that inhibits the signaling of the interleukin-4 (IL-4) and interleukin-13 (IL-13) proteins 3 and is not an immunosuppressant. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. 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. Also if your insurance does cover,Dupixent offers a co-pay card that. Dupixent MyWay pays the $500 copay. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. 00 per injection. DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. DUPIXENT MyWay Ambassador. Section 5a. 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. Injection in children 12 and older should be supervised by an adult. 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. 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. Dupixent MyWay pays the $500 copay. 23. PRESCRIBER TO FILL OUT Section 6a. 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. What it is used for. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Income at or below: Not Published: Medical expenses can be. I’m a registered nurse with DUPIXENT MyWay. 22. My wife is on Dupixent, and has the MyWay card which allows up to $13,000/year. And I would experience blurry vision, red and itchy eyes. 67 mL, 200 mg/1. Serious side effects can occur. any time by mailing or faxing a written request to DUPIXENT MyWay at 1800 Innovation Point, Fort Mill, SC 29715; Fax: 1-844-387-9370. DUPIXENT . 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. Need additional guidance with the enrollment process? Call DUPIXENT MyWay at 1-844-387-4936 Monday through Friday, 8 am to 9 pm Eastern Time. Since MyWay covers 13,000 a year, that will count towards your deductible. Program Website : Patient Assistance Applications for DUPIXENT® dupilumab therapy My Information. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. for DUPIXENT® dupilumab therapy My Information. If requested, I agree to provide proof of income within thirty (30) days of the request. He continued with Dupixent and his symptoms had partially improved 24 weeks after their onset. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. a,b a Data on file, Sanofi and Regeneron, US. I’m a registered nurse with DUPIXENT MyWay. 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. Please see Important Safety Information and Prescribing Information and Patient Information on website. Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. Your doctor will tell you how much DUPIXENT to inject and how often to inject it. DUPIXENT can be used with or without topical corticosteroids. LH Patient View; data through June 16, 2023. Serious adverse reactions may. with household income, to qualify. DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. Lancet. 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. Im so stressed out about. 8K subscribers in the eczeMABs community. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. 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. DUP. -The original form (from the first guy) was still in the system and the folks at MyWay were “confused” by it. Fill out sections 5a and 5b completely to determine patient eligibility. 23. Manufacturer Coupon. Complete the entire form and submit pages 1-3 to DUPIXENT MyWay® via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm ET Enrollment Form FOR ALLERGISTSThe price you pay for Dupixent can vary. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. The appeal process Example letters. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. For more information, call 1. 14 mL, or 300 mg/2 mL)Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. I suppose it doesn't really matter now. Type text, add images, blackout confidential details, add comments, highlights and more. DUPIXENT MyWay. 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 . $0 is the amount you pay. 00 copay. March 27, 2018. I. - Rachel, DUPIXENT Patient Mentor, living with asthma. 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. 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. 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 otherDUPIXENT . Please see accompanying full Prescribing Information. 2 pens of 300mg/2ml. ) Please refer to Section 8, Patient Certifications, for. Please see Important Safety Information and Patient Information on. Dupixent is currently approved in the U. 2 Eligible US residents with an FDA-approved prescription for DUPIXENT may pay as little as $0 copay per fill of DUPIXENT (annual maximum of $13,000). 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. 34 milliliters 200 mg/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. Income at or below: Not Published: Medical expenses can be deducted from reported income:. It’s a change in how copay assistance and coupons are counted toward your. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. DUPIXENT MyWay ENROLLMENT FORMS; English Enrollment Form. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. 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. Program has an annual maximum of $13,000. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. Rx: DUPIXENT® (dupilumab) (100 mg/0. 14 mL; and 300 mg per 2 mL. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. 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). I just spoke to someone through the MyWay Program. If you have an adjusted net income or adjusted household net income between $30,000 and $32,000, you may receive a reduced supplement amount. 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. If your office does not use a preferred specialty pharmacy, leave the box unchecked to indicate that you would like DUPIXENT MyWay to conduct the benefits investigation on the patient’s behalf. Enroll eligible patients in the DUPIXENT MyWay® patient support program for DUPIXENT® (dupilumab) access, financial assistance & nursing support. living with prurigo nodularis. 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. Coverage varies by type and plan. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). “It’s an incredible feeling to be validated and. Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. Eligible patients will receive their cards by email. Susie16 Aug 29, 2023 • 2:03 AM. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. DUPIXENT® is indicated as an add-on maintenance treatment of adult and pediatric patients 6 years and older with moderate-to-severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid dependent asthma. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. In clinical trials, DUPIXENT reduced the. 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. com. Approximately 72% of the total FEV 1 improvement (470 mL improvement at Week 52 from baseline FEV 1 of 1. 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. 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. 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. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. With the DUPIXENT MyWay Copay Card, eligible,. DUPIXENT is not a steroid or immunosuppressant; it is a prescription biologic medicine given under the skin (subcutaneous injection). 10 for placebo; difference between Dupixent and placebo: -2. Data on file, Regeneron Pharmaceuticals, Inc. DUPIXENT is taken by injection under the skin (subcutaneous injection) once every two weeks. It contains 300 mg of DUPIXENT for injection under the skin (subcutaneous injection). About 75,000 adults in the U. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. if speciality. ago. 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. Program Website : Patient Assistance Applicationsfor DUPIXENT® dupilumab therapy My Information. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. For more information, dial 1‑844‑DUPIXENT ( 1-844-387-4936 ), option 1 Monday-Friday, 8 am - 9 pm ET. The DUPIXENT MyWay program also provides useful tools and resources to help you stay on track with your treatment. How to fill out dupixent reimbursement: 01. 0254 Last Update: February 2023 DUP. The fax number is 1. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. Option 1- you have to meet your deductible without Dupixent myway. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. 0254 Last Update: February 2023 DUP. 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. 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. For more information, call 1. DUPIXENT was studied in adults and children 6 months of age and older. 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. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Please see Important Safety Information and Prescribing Information and Patient Information on website. Sanofi and Regeneron are committed to helping patients in the U. 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. 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. My doctor gave me a copay card to cover mine. Each time you fill your DUPIXENT prescription, please ensure your. 0129 Last Update:. 99% of commercial patients (6+ months of age) nationally are covered for DUPIXENT. 0156 Last Update: March 2023 DUP. For more information, dial 1-844-DUPIXENT 1-844-387-4936 ), option 5, Monday-Friday, 9 am – 9 pm ET. 89 and -1. Subcutaneous Solution 100 mg/0. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded. Program possessed one annual maximum from $13,000. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. I understand that. 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. r/eczema • I wish there was an eczema simulator so others could feel what we do when they say “don’t. 71 for Dupixent compared to 0. At one point, I was getting cold sores every 2 to 3 weeks consistently. A quantity of Dupixent will be considered medically necessary if the above criteria are met, as indicated in the table below:.