DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. Required if enrolling in the DUPIXENT MyWay. 17 and 0. 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. If you are a New York prescriber, please use an original New York State. 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. Children 6 to 11 years of age . dupixent myway income guidelinesstellaris unbidden and war in heaven. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. THE DUPIXENT MyWay COPAY CARD. 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). *For patients on DUPIXENT 300 mg in a 24-week and a 52-week clinical trial vs 17% for placebo group. 2 cartons. 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. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Access the dupixent reimbursement form either online or through your healthcare provider. Subcutaneous Solution 100 mg/0. Share your form with others. Although you are not eligible, you can sign up DUPIXENT MyWay. 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. THE DUPIXENT MyWay PROGRAM. I have read and agree to the Income Verification included in Section 8 on page 5. A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. • DUPIXENT can be stored at room temperature up to 77°F (25°C) up to 14 days. Patient to Fill Out. Rx: DUPIXENT® (dupilumab) (100 mg/0. Biologic Drug: Biologic drugs are made from living cells and are often expensive. Option 1- you have to meet your deductible without Dupixent myway. DUPIXENT can be used with or without topical corticosteroids. 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. 0129 Last Update:. DUPIXENT is not a steroid or immunosuppressant; it is a prescription biologic medicine given under the skin (subcutaneous injection). Patient has been compliant on Dupixent therapy 4. 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 you don't have insurance at all, the only realistic option is to qualify for income-based help from Dupixent directly. DUPIXENT® (dupilumab), in moderate-to-severe asthma treatment, is taken as an injection by a pre-filled syringe or pre-filled pen, review both options here. 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. financial assistance for eligible patients, provide one-on-one nursing support, and more. (2 of 3) Patient signature/Legal representative if patient is <18 years Date Section 2. Clip the card and save • Save up to 80% on medications* Tell your healthcare provider about any new or worsening joint symptoms. The appeal process Example letters. 14 mL, or 300 mg/2 mL)The Dupixent MyWay program is not available to medicare patients. DUPIXENT® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. 23. If I am completing Section 5b, I authorize for my commercially insured patient one. 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. I have applied for grants, financial hardships (my household income surpasses every programs caps, even with 6 children), etc and now I'm just being told to pay $3,000/month or too bad. 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 MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. Not valid for prescriptions paid, in whole or in part, by Medicaid, Medicare, VA, DOD, TRICARE, or. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. 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. 1,000-125=875 $875 is the amount your health insurance pays. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. Support. 01. Rx: DUPIXENT® (dupilumab) (100 mg/0. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay, and that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. DUPIXENT® ® 1-844-387-9370 or Document Drop at (code: 8443879370) In adults and children 6 years and older, your initial dose of DUPIXENT is 2 injections under the skin (subcutaneous injection) at different injection sites. 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. At one point, I was getting cold sores every 2 to 3 weeks consistently. 14 mL, or 300 mg/2 mL)Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. 14 mL, or 300 mg/2 mL)My insurance provider covers 85% and our Canadian version of 'MyWay' pays the remainder. It should only be given by an adult caregiver in children 6 to 11 years of age. 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. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. Ways to save on Dupixent. Also if your insurance does cover,Dupixent offers a co-pay card that. Learn about the DUPIXENT® (dupilumab) mechanism of action inhibiting IL-4 and IL-13 signaling in appropriate asthma patients. If you have any additional questions about this pricing information, please call DUPIXENT MyWay at 1-844-DUPIXENT (1-844-387-4936). DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. But either way, after you or Dupixent myway meets your deductible, it should be free to you. Fill out the form accurately and completely, providing all. 01. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. Just got off the phone with Dupixent My Way. 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. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. I'm "only" 61 now though on Dupixent MyWay copay help. Social Security income, unemployment insurance benefits, disability income, any other income for the household. -The original form (from the first guy) was still in the system and the folks at MyWay were “confused” by it. 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. $125 is the amount Dupixent assistance pays. According to the manufacturers, Dupixent can be dosed to a maximum daily dose as indicated below. financial assistance for eligible patients, provide one-on-one nursing. 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. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. If I am completing Section 5b, I authorize for my commercially insured patient one. 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. Some Medicare plans may help cover the cost of mail-order drugs. Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8. The DUPIXENT MyWay program also provides useful tools and resources to help you stay on track with your treatment. g. That is good, because I was quoted 1400+ a month by my Medicare D provider. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. The Dupixent MyWay program is not available to medicare patients. Oct 26, 2022 · Dupixent MyWay Program Enrollment Form for Allergists (AD, Asthma, CRSwNP). Dupixent will run about $3000 per month with my insurance until my maximum is met. 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). After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. Decreased utilization of rescue medications 3. Please see. 01. With the DUPIXENT MyWay Copay Card, eligible,. Robocalls increase diabetic retinopathy screenings in low-income patients. The most common side effects include: DUPIXENT MyWay. It is not an immunosuppressant or a steroid. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. 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 . Fax the Enrollment Form to DUPIXENT MyWay. There is another biologic very similar to Dupixent called Adbry. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. Maybe try that while waiting for the Dupixent. LONG-LASTING CLEARER SKIN AT 16 and 52 Weeks 22% taking. These programs and tips can help make your prescription more affordable. Enroll eligible patients in the DUPIXENT MyWay® patient support program for DUPIXENT® (dupilumab) access, financial assistance & nursing support. Dupixent MyWay Program Dupixent (dupilumab injection). Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 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. A case series of 12 people prescribed Dupixent reported an average weight gain of 6. 67 mL, 200 mg/1. 02. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. I just started this week so I look forward to seeing the results. Manufacturer Coupon. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. Effective Sept. 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. 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. Fill out sections 5a and 5b completely to determine patient eligibility. Dupixent is not intended for episodic use. chevron_right. You can email or print the enrollment forms below. Program has an annual maximum of $13,000. He continued with Dupixent and his symptoms had partially improved 24 weeks after their onset. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and processed by 1‑844‑DUPIXENT 1-844-387-4936. You may be able to lower your total cost by filling a greater quantity at one time. Please see Important Safety Information and Patient Information on. Your insurance has to deny twice and then you can apply for patient assistance. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 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. 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. PRESCRIBER TO FILL OUT Section 6a. 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. • Store DUPIXENT in the refrigerator at 36°F to 46°F (2°C to 8°C). Be sure to fill out your enrollment form completely and accurately. 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. $4,930. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. DUPIXENT MyWay Ambassador. Click Tap to Learn More In an open-label extension study, the long-term safety profile of DUPIXENT ± TCS in pediatric patients observed through Week 52 was consistent with that seen in adults with atopic dermatitis, with hand-foot-and-mouth disease and skin papilloma (incidence ≥2%) reported in patients 6 months to 5 years of age. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. Dupixent MyWay pays the $500 copay. 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. Eligible clients will receive their cards by email. E. I’m Laurie. It was granted and I pay $0. DUPIXENT MyWay. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. Support. 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 other4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pmDUPIXENT MyWay complements your office’s process for accessing DUPIXENT. DUPIXENT MyWay®. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. chevron_right. DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. XXXX 00/0000 b y: A B C c o m pa n y, I n c. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. how to afford it then - it's been so helpful!! 3 Reactions. Eosinophilic Esophagitis: DUPIXENT is indicated for the treatment of adult and pediatric patients aged 12 years and older, weighing at least 40 kg, with eosinophilic esophagitis (EoE). I understand that. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. S. 00 copay. To enroll or obtain information call 1-877-311. Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to therapy whether they are uninsured, lack. Since MyWay covers 13,000 a year, that will count towards your deductible. ) 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). 67 mL; 200 mg per 1. Enroll now to receive emails and resources designed to help patients, caregivers and information seekers through the DUPIXENT® (dupilumab) treatment journey. 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. Learn how DUPIXENT helped treat children 6 to 11 years old with their moderate-to-severe asthma. financial assistance for eligible patients, provide one-on-one nursing support, and more. 8K subscribers in the eczeMABs community. Monday-Friday, 8 am - 9 pm ETto DUPIXENT MyWay at 1-844-387-9370. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. 09. Regeneron and Sanofi are committed to helping patients in the U. How many people live in your household? _____ Please refer to. For more information or to enroll in the patient support program, contact us at: 1‑844‑DUPIXENT. Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. DUPIXENT MyWay®. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. 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. If necessary, DUPIXENT may be kept at room temperature up to 77 °F (25 °C) for a maximum of 14 days. Serious adverse reactions may occur. Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI, and demonstrate a. Please see Important Safety Information and full PI on website. 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. 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. for DUPIXENT® dupilumab therapy My Information. DUPIXENT can cause serious side effects, including: The most common side effects in patients with eczema include. 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. I suppose it doesn't really matter now. 23. 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. 00 per injection. 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. Please see accompanying full Prescribing Information. Appears that my out of pocket maximum will be $8000 through insurance. 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. 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. If you are a New York prescriber, please use an original New York State prescription form. 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. THIS IS NOT INSURANCE. 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 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. Over 80% of insurance plans cover Dupixent, but many have restrictions. ) Please refer to Section 8, Patient Certifications, for. I knocked out the first copay out of pocket and went on the manufacturer website and applied for the dupixent my way card. A quantity of Dupixent will be considered medically necessary if the above criteria are met, as indicated in the table below:. 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. Dupixent® (dupilumab) approved by FDA as the first and only treatment indicated for prurigo nodularis Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3. 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. 2 Eligible US residents with an FDA-approved. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. The U. I also have the dupixent myway card that covers a total of $13,000 for the year. 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. My doctor gave me a copay card to cover mine. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help scheduling deliveries any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 0kg. including household income, to qualify. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. Data on file, Regeneron Pharmaceuticals, Inc. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. Using the drop. A group of skin conditions characterized by skin inflammation, rash, and itch. 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. You can email or print the enrollment forms below. ®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. Financial criteria for patient assistance. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. You may be able to lower your total cost by filling a greater quantity at one time. Connect with someone, ask questions, and learn about their experience with DUPIXENT® (dupilumab) treatment. 1 Reactions. 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. Governed and delivered by Service Canada. 23. 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. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. 0185 Last Update: November 2022 DUP. chevron_right. 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. My wife is on Dupixent, and has the MyWay card which allows up to $13,000/year. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. So the nurse told me to fax receipts for year to date prescriptions and last year's income forms (W2, 1099, etc). Dupixent Myway . I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Form more information phone: 844-387-4936 or Visit website Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). 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. 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. 0252 Last Update: Feb 2023 DUP. Lot EXP Mfd. DUPIXENT is taken by injection under the skin (subcutaneous injection) once every two weeks. The average cash price for a 30-day supply of Dupixent is $5,298. The formulary status tool below can help check DUPIXENT coverage for various plans. . Susie16 Aug 29, 2023 • 2:03 AM. 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 . ) Please refer to Section 8, Patient Certifications, for. with household income, to qualify. 00, but I do have some money invested. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. Section 5a. Dupixent. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. 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. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. form on DUPIXENT. Monday-Friday, 8 am-9 pm ET. In an open-label extension study, the long-term safety profile of DUPIXENT ± TCS in pediatric patients observed through Week 52 was consistent with that seen in adults with. Gather all necessary information and documents, such as your insurance information, prescription details, and any supporting documentation. Please see. ( 1-844-387-4936 ), option 1. Your doctor will tell you how much DUPIXENT to inject and how often to inject it. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. 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. Copay Card or you wish to discontinue your participation, please contact us. ) 2 Prescription InformationIn adults and children 6 years and older, your initial dose of DUPIXENT is 2 injections under the skin (subcutaneous injection) at different injection sites. Check the liquid in the prefilled pen or syringe. I have applied for grants, financial hardships (my household income surpasses every programs caps, even with 6 children), etc and now I'm just being told to pay $3,000/month or too bad. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. Fill out sections 5a and 5b completely to determine patient eligibility. Denied because of 2022 income threshold for household of two. The DUPIXENT MyWay team can research each patient's situation and determine 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. - Rachel, DUPIXENT Patient Mentor, living with asthma. 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. 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. Dupixent MyWay pays the $500 copay. 26 [95% CI: 0. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. living with prurigo nodularis. Serious side effects can occur. 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. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. 67 mL, 200 mg/1. . 67 mL, 200 mg/1. Each time you fill your DUPIXENT prescription, please ensure your. 2022;400 (10356):908-919. United Healthcare covers it but I get insurance through my employer and it was a huge pain to get approved. LASTING CHANGE IS ACHIEVABLE. 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. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. Sign up or activate your card here. 14 mL Dupixent subcutaneous solution from $3,787. Type text, add images, blackout confidential details, add comments, highlights and more. 06 and -1. Please see accompanying full Prescribing Information. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. 1kg over one year – the amount of weight gained ranged from 0. Asthma: DUPIXENT is indicated as an add-on maintenance treatment of adult and pediatric patients aged 6 years and older with moderate-to-severe asthma characterized. Once I got a new job, I called Dupixent MyWay to tell them my status changed and I could now get drugs through my insurance's specialty pharmacy. If you are a New York prescriber, please use an original New York. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. Get a Quick Start. Household Size. Assistance may be available for patients who do not have insurance. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. ago. 1. Type text, add images, blackout confidential details, add comments, highlights and more. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. For more information, dial 1-844-DUPIXENT 1-844-387-4936 ), option 5, Monday-Friday, 9 am – 9 pm ET. Patient is responsible for any out-of-pocket amounts that exceed the program limit. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. 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. 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. I give supplemental injection training to the patient and the patient’s caregiver. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded. For patients with commercial insurance who are new to DUPIXENT and experiencing a. DUPIXENT can be used with or without topical corticosteroids. If I am completing Section 5b, I authorize for my commercially insured patient one. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. To contact DUPIXENT MyWay, please call 1-844-DUPIXENT (1-844-387-4936). Approximately 72% of the total FEV 1 improvement (470 mL improvement at Week 52 from baseline FEV 1 of 1. 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. will need to meet the eligibility criteria, including household income, to qualify. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. 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. Learn why DUPIXENT® (dupilumab) may be an. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Dupixent MyWay Copay Card. Continuation in the program is conditioned upon timely verification of income. 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. Your office may choose to use a preferred specialty pharmacy to start the benefits investigation. 0254 Last Update: February 2023 DUP. Monday-Friday, 8 am-9 pm ET. 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. If requested, I agree to provide proof of income within thirty (30) days of the request. TEL: 844. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. 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.