Your cost may depend on your treatment plan, your insurance coverage (if you have it), and the pharmacy you use. A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. 89 and -1. 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. 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. Financial criteria for patient assistance. 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). 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. To enroll or obtain information call 1-877-311. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. I knocked out the first copay out of pocket and went on the manufacturer website and applied for the dupixent my way card. 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. Monday-Friday, 8 am-9 pm ET. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. If I am completing Section 5b, I authorize for my commercially insured patient one. 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. 09. Hear real patients stories of life with uncontrolled moderate-to-severe asthma and how discovering DUPIXENT® (dupilumab) impacted their journey. 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). Children treated with Dupixent and topical corticosteroids (TCS) achieved clearer skin, experienced significantly improved overall disease severity and significantly reduced itch compared to TCS. How many people live in your household? _____ Please refer to. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. Lancet. S. It was granted and I pay $0. 14 mL; and 300 mg per 2 mL. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. Dupixent side effects. Option 1- you have to meet your deductible without 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. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. 2 pens of 300mg/2ml. 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. Just got off the phone with Dupixent My Way. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. 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. Monday-Friday, 8 am - 9 pm ETto DUPIXENT MyWay at 1-844-387-9370. ®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. Note: All information is required unless otherwise indicated. For more information or to enroll in the patient support program, contact us at: 1‑844‑DUPIXENT. 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. Dupixent MyWay Program CONTACT INFO: Address:, Phone: 1-844-387-4936: Provider Phone: Fax: 1-844-387-3970: Website: Program Website: ELIGIBILITY Eligibility Info:. - Rachel, DUPIXENT Patient Mentor, living with asthma. out and fax back to DUPIXENT MyWay at 1-844-387-9370 • You or your specialist can call 1-844-DUPIXEN(T), option 1 • Providing your email address allows DUPIXENT MyWay to give you more support resources about DUPIXENT. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Support. 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. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. 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. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. March 29, 2018. b Data as of January 2023. 03. My doctor gave me a copay card to cover mine. 2 cartons. 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® 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. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Monday-Friday, 8 am-9 pm ET. $125 is the amount Dupixent assistance pays. 67 mL Dupixent subcutaneous solution from $3,787. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. Fill out the form accurately and completely, providing all. Last time I checked income didn’t matter? The only way it became affordable for me was to get the deluxe package of my insurance. For more information, call 1. Boguniewicz M, Alexis AF, Beck LA, et al. Patient has been compliant on Dupixent therapy 4. 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). For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit . And, if you're eligible, you can sign up and receive your card today. Have commercial insurance, including health 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 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. Approval represents the second dermatology indication for Dupixent and fifth disease indication overall in the. Robocalls increase diabetic retinopathy screenings in low-income patients. For more information, dial 1‑844‑DUPIXENT 1-844-387-4936 Monday-Friday, 8 am-9 pm ET. Please see Dosage Regimens, How to Inject DUPIXENT® and Instructions for Use. $0 is the amount you pay. Sign it in a few clicks. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not ENROLL. 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. Dupixent will run about $3000 per month with my insurance until my maximum is met. 0129 Last Update:. At one point, I was getting cold sores every 2 to 3 weeks consistently. S. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. Rx: DUPIXENT® (dupilumab) (100 mg/0. will need to meet the eligibility criteria, including household income, to qualify. Im so stressed out about. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. With the DUPIXENT MyWay Copay Card, eligible,. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. 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. 78 L) was seen at Week 2 in patients taking DUPIXENT 200 mg Q2W + SOC (n=264) (baseline blood EOS ≥300 cells/μL, QUEST, secondary endpoint). Please see Important Safety Information and Prescribing Information and Patient Information on website. Does anyone know of any assistance programs I can use to help assist in the copay after dupixent my way limit is reached?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 (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. How much does Dupixent cost without insurance? The average monthly retail price of Dupixent is $4,910 per 2, 2 mL of 300 mg/2 mL prefilled syringes. 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. The Dupixent MyWay program is not available to medicare patients. 14 mL Dupixent subcutaneous solution from $3,787. 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 is not used to treat sudden breathing problems. 0252 Last Update: Feb 2023 DUP. ) 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). 2 cartons. Dupixent will run about $3000 per month with my insurance until my maximum is met. Clip the card and save • Save up to 80% on medications* Tell your healthcare provider about any new or worsening joint symptoms. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. 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). It is not an immunosuppressant or a steroid. if speciality. If you are a New York prescriber, please use an original New York State prescription form. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. 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. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. 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. 06 and -1. 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. 89 and -1. I just started this week so I look forward to seeing the results. DUPIXENT can be used with or without topical corticosteroids. 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. It may be covered by your Medicare or insurance plan. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. Patient is responsible for any out-of-pocket amounts that exceed the program limit. ) I agree that Regeneron Pharmaceuticals, Inc. 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. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. Fill a 90-Day Supply to Save. Dupixent MyWay ™ will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket costs. comfysnail • 1 yr. 50 for a single person. Needed additional leadership equipped the enrollment process? Contact your section accessories dedicated or call DUPIXENT MyWay. Use DUPIXENT exactly as prescribed by your doctor. 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® (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. O. For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. ) Please refer to Section 8, Patient Certifications, for. DUPIXENT can be used with or without topical corticosteroids. 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. 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® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials About 75,000 adults in the U. 1kg over one year – the amount of weight gained ranged from 0. 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. for DUPIXENT® dupilumab therapy My Information. 38]). 1kg to 18. 0252 Last Update: Feb 2023 DUP. DUPIXENT can be used with or without topical corticosteroids. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. C M ET DUPIXENT MYWAY ENROLLMENT FORM Moderate-to-Severe Atopic Dermatitis SUBMIT COMPLETED PAGES 1 & 2 Fax: 1-844-387-9370 Document Drop: (code: 8443879370)The DUPIXENT MyWay Copay Card Program includes the Copay Card, the Debit Card, and any direct patient rebate, and has a combined annual maximum benefit of $13,000 per patient per calendar year. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not 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) Section 5a. Surgery may remove your nasal polyps, but it may not treat an underlying cause of inflammation—allowing them to grow back. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. Does anyone know of any assistance programs I can use to help assist in the copay after dupixent my way limit is reached?I experienced cold sores and eye issues for about the first 6 months of being on Dupixent. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. If requested, I agree to provide proof of income within thirty (30) days of the request. chevron_right. Please see accompanying full Prescribing InformationTell us about yourself. DUPIXENT . Connect with someone, ask questions, and learn about their experience with DUPIXENT® (dupilumab) treatment. Patient assistance program. 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. Browse the DUPIXENT® (dupilumab) sitemap to help you learn more about uncontrolled moderate- to-severe eczema in adults and children aged 6 months & older and navigate DUPIXENT. • DUPIXENT can be stored at room temperature up to 77°F (25°C) up to 14 days. 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. For more information, call 1. 1, 2022, the gross income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility in Minnesota increased from 165% to 200% of the federal poverty line for most households. It took the price from 2K to 1K. Serious side effects can occur. LONG-LASTING CLEARER SKIN AT 16 and 52 Weeks 22% taking. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. for DUPIXENT® dupilumab therapy My Information. And I would experience blurry vision, red and itchy eyes. 00 copay. g. For assistance, please call 1-844-468-2252 Monday Friday, 8AM to 8PM ET. 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. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. Please see Important Safety Information and Patient Information on website. Appears that my out of pocket maximum will be $8000 through insurance. 0254 Last Update: February 2023 DUP. 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. 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). 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. I also have the dupixent myway card that covers a total of $13,000 for the year. Serious adverse reactions may. E. The doctor's office called to say I need to call to talk about my income and expenses. Check the liquid in the prefilled pen or syringe. 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. Some Medicare plans may help cover the cost of mail-order drugs. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Caring. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit got Dupixent MyWay copay assistance and they never asked one question about my income. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. If you are a New York prescriber, please use an original New York State prescription form. 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). I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Fill out sections 5a and 5b completely to determine patient eligibility. This DUPIXENT Pre-filled Pen is a single-dose device. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as a $0* copay per fill of DUPIXENT, maximum of $13,000 per patient per calendar year. 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. We are finding the Dupixent MyWay program to be quite challenging to understand; we don't know whether that might be an option, and we are looking at other options, even expensive ones. Serious adverse reactions may occur. Sign up or activate your card here. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. LH Patient View; data through June 16, 2023. 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 Monday-Friday, 8 am - 9 pm ET. It was a process to get into the patient assist program. 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. For patients with commercial insurance who are new to DUPIXENT and experiencing a. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. Section 5a. 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. 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. Your insurance has to deny twice and then you can apply for patient assistance. 0129 Last Update:. 00, but I do have some money invested. How many people live in your household? _____ Please refer to Section 8, Patient Certifications , for. DUPIXENT can cause serious side effects, including: The most common side effects in patients with eczema include. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. A quantity of Dupixent will be considered medically necessary if the above criteria are met, as indicated in the table below:. 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. I pay for it with my insurance and the myway copayment program. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. Eligible commercially insured patients may pay $0 per prescription with a maximum savings of $13,000 per year; for additional information contact the program at 844-387-4936. will not conduct a benefits verification. 22. 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. 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 not affect any disclosure of My Information based on1-844-DUPIXENT 1-844-387-4936. Quantity Limits: Dupixent: 200 mg/1. 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. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. Rx: DUPIXENT® (dupilumab) (100 mg/0. Please see accompanying full Prescribing Information. You can email or print the enrollment forms below. Each time you fill your DUPIXENT prescription, please ensure your. Denied because of 2022 income threshold for household of two. form on DUPIXENT. DUPIXENT was studied in adults and children 6 months of age and older. 67 mL, 200 mg/1. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based onto DUPIXENT MyWay at 1-844-387-9370. Please note that you will receive a confirmation fax after sending the form. 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. You may be able to get a 90-day supply of Dupixent. Especially tell your healthcare provider if you. 67 mL, 200 mg/1. How many people live in your household? _____ Please refer to. When I was very young, I knew that I wanted to be a nurse. 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. LEARN ABOUT OUR PATIENT SUPPORT PROGRAM. 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. 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. If necessary, DUPIXENT may be kept at room temperature up to 77 °F (25 °C) for a maximum of 14 days. Section 5a. 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. After that, we will have met our family deductible. Serious side effects can occur. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. 23. 58 for 1. Since MyWay covers 13,000 a year, that will count towards your deductible. 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. 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. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will notFor any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T)(1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. 2022;400 (10356):908-919. Get a Quick Start. About Dupixent. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 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. 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. I’m a registered nurse with DUPIXENT MyWay. There is currently no generic alternative to Dupixent. Registered nurses are also available to speak with eligible patients about DUPIXENT. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. How to fill out dupixent reimbursement: 01. 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. Using the drop. Household Size. 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. THE DUPIXENT MyWay PROGRAM. If you don’t have health insurance, talk. Tell your healthcare provider about any new or worsening joint symptoms. It's like $35k-$40k. DUPIXENT can be used with or without topical corticosteroids. You have to game the system instead of trying to get full coverage. Subcutaneous Solution 100 mg/0. I've been on Dupixent for over 2 years now and it has been such a great experience keeping my eczema under control. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. I just got approved thru Dupixent my way for a year of free medication. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. Patient Signature _____ If you have questions about the . 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. Serious side effects can occur. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. The patient would prefer not to try. So the nurse told me to fax receipts for year to date prescriptions and last year's income forms (W2, 1099, etc). Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. If you are a New York prescriber, please use an original New York. 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. ago. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 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. 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. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. 67 mL; 200 mg per 1. 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. 03. chevron_right. They never mentioned only covering a. 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. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. DUPIXENT® (dupilumab) is a. Share your form with others. If I am completing Section 5b, I authorize for my commercially insured patient one. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. 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 still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. 03. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. DUPIXENT® (dupilumab) is taken as an injection by a pre-filled syringe or pre-filled pen. 2017;5 (6):1519-1531. 80). *For patients on DUPIXENT 300 mg in a 24-week and a 52-week clinical trial vs 17% for placebo group. 0185 Last Update: November 2022 DUP. Please see Important Safety Information and Prescribing Information and Patient Information on website. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. 26 [95% CI: 0. Patient is responsible for any out-of-pocket amounts that exceed the program limit. Children 6 to 11 years of age . DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. With the DUPIXENT MyWay Copay Card, eligible,. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. including household income, to qualify. Please see. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. Patients in each age group saw improved lung function in as little as 2 weeks. Do NOT shakeConoce las dos opciones de administración disponibles: jeringa precargada de 200 mg y 300 mg, y pluma precargada de 200 mg y 300 mg (para edades de 12 años o más), y revisa cómo inyectar DUPIXENT® (dupilumab), un medicamento para inyección subcutánea, de venta con receta, para el eczema moderado a grave en adultos y niños de 6 meses o más. 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. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm01. Type text, add images, blackout confidential details, add comments, highlights and more. Dupixent is an injection that is usually given under the skin every other week for the treatment of asthma, eczema, and some other inflammatory conditions. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Program has an annual maximum of $13,000. Data on file, Regeneron Pharmaceuticals, Inc. Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. QUEST (12+ years) DUPIXENT offers rapid breathing relief patients can feel as early as Week 2. If you’re the spouse or. Dupilumab. 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). , 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. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. 01. You don’t have to put your life on hold to fit your dosing schedule. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded; DUPIXENT should not be exposed to heat or direct sunlight; Do NOT freeze. 1,000-125=875 $875 is the amount your health insurance pays. The DUPIXENT MyWay team can research each patient’s situation and determine eligibility. S. 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. The $500 payment counts towards the member’s deductible and out-of-pocket maximum. Since 2017, Dupixent has increased in price by 13%. A case series of 12 people prescribed Dupixent reported an average weight gain of 6. 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. Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. 14 mL, or 300 mg/2 mL) Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. Dupixent on a High Deductible Health Plan. Experience: Been on Dupixent since May 15, 2017. See All. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. Support. 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. 23.