Enroll eligible patients in the DUPIXENT MyWay® patient support program for DUPIXENT® (dupilumab) access, financial assistance & nursing support. Fill out sections 5a and 5b completely to determine patient eligibility. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Use DUPIXENT exactly as prescribed by your doctor. Please see. It may be covered by your Medicare or insurance plan. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. ago It is actually not a change in 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. 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. Eczema. DUP. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. 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. Manufacturer Coupon. 2022;400 (10356):908-919. Using the drop. ®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 have prescribed DUPIXENT to the Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. with household income, to qualify. Data on file, Regeneron Pharmaceuticals, Inc. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. 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. Patient is responsible for any out-of-pocket amounts that exceed the program limit. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. Since 2017, Dupixent has increased in price by 13%. Declining androgen levels correlated with increased frailty. Required if enrolling in the DUPIXENT MyWay. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. Appears that my out of pocket maximum will be $8000 through insurance. Compare . DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. Eligible clients will receive their cards by email. 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. ) Please refer to Section 8, Patient Certifications, for. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. 5. TEL: 844. I just spoke to someone through the MyWay Program. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. 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. See All. If this is the case, write the preferred specialty pharmacy. Maximum Monthly Gross Income. 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. 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. Appears that my out of pocket maximum will be $8000 through insurance. Box 5925 Mailstop 55A-220A Bridgewater, NJ 08807. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Serious side. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. 23. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. 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. 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 language of the MyWay program back then never mentioned the $13,000 limit: they simply asked for income requirements, etc. 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. Serious side effects can occur. 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. 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. If you are a New York prescriber, please use an original New York. I’ve been with DUPIXENT MyWay since the very beginning. 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. Advertisement. 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. S. ) I agree that Regeneron Pharmaceuticals, Inc. dupixent myway income guidelinesstellaris unbidden and war in heaven. 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. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. 38]). 01. DUP. 14 ml, 300 mg/2 ml: Asthma, atopic dermatitis: 3 syringes for the first 28 days. 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. Serious side effects can occur. THE DUPIXENT MyWay PROGRAM. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Needed additional leadership equipped the enrollment process? Contact your section accessories dedicated or call DUPIXENT MyWay. 0129 Last Update:. Children treated with Dupixent and topical corticosteroids (TCS) achieved clearer skin, experienced significantly improved overall disease severity and significantly reduced itch compared to TCS. 22. If you are a New York prescriber, please use an original New York State. 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. 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. I don't know what medical issues your son is having, but it's likey autoimmune issues. 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. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. 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. 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. Follow these tips to take DUPIXENT while traveling: Store DUPIXENT in the original carton to protect it from light. Decreased exacerbations and/or improvement in symptoms 2. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. living with prurigo nodularis. Fill a 90-Day Supply to Save. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. DUPIXENT should not be stored above 77 °F (25 °C). United Healthcare covers it but I get insurance through my employer and it was a huge pain to get approved. 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. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. Clip the card and save • Save up to 80% on medications*Tell your healthcare provider about any new or worsening joint symptoms. Rx: DUPIXENT® (dupilumab) (100 mg/0. For more information, call 1. Section 5a. There is currently no generic alternative to Dupixent. If approved by your insurance company, getting a 90-day supply of the drug could reduce your number of. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. If you are a New York prescriber, please use an original New York State prescription form. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. 0252 Last Update: Feb 2023 DUP. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. LH Patient View; data through June 16, 2023. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. 17 and 0. 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. Oct 26, 2022 · Dupixent MyWay Program Enrollment Form for Allergists (AD, Asthma, CRSwNP). Social Security income, unemployment insurance benefits, disability income, any other income for the household. , chart notes, laboratory values) and use of claims history documenting the following: 1. I have a $40 copay but I got the dupixent my way copay card its free for me. DUPIXENT® (dupilumab) is a. Dupixent has been studied in more than 8,000 patients ages 6 years and older across more than 40 clinical trials. Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 01. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). 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. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. With the DUPIXENT MyWay Copay Card, eligible,. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. XXXX 00/0000 b y: A B C c o m pa n y, I n c. S. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. Some Medicare plans may help cover the cost of mail-order drugs. Please see. 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. I have read and agree to the Income Verification included in Section 8 on page 5. 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. DUPIXENT was studied in adults and children 6 months of age and older. If you are a New York prescriber, please use an original New York State prescription form. 2 cartons. Household Size. 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). ithdrawal of this Authoriation will end my participation in the DUPIXENT MyWay Program and will not aect any disclosure of My Information ased on this Authoriation made efore my reuest is received and processed y my ealthcare Providers, ealth Insurers, and Specialty Pharmacies. Dupixent is currently approved in the U. For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. 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. 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. Watch videos from experts [,download materials,] and explore future events to further understand DUPIXENT® (dupilumab). Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. Support. I’ve been with DUPIXENT MyWay since the very beginning. store above 77 °F (25 °C). Serious adverse reactions may. Just got off the phone with Dupixent My Way. Regeneron and Sanofi are committed to helping patients in the U. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Support. Boguniewicz M, Alexis AF, Beck LA, et al. a,b a Data on file, Sanofi and Regeneron, US. Please see Important Safety Information and Prescribing Information and Patient Information on website. I just got approved thru Dupixent my way for a year of free medication. Pay as little as $0 per month. Dupixent will run about $3000 per month with my insurance until my maximum is met. Most do, some don't. Copay Card or you wish to discontinue your participation, please contact us. will not conduct a benefits verification. DUPIXENT MyWay® Program Taking Dupixent. Eligible patients will receive their cards by email. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. To contact DUPIXENT MyWay, please call 1-844-DUPIXENT (1-844-387-4936). 25%) Taro Pharma patient access. 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. Dupixent MyWay Program Dupixent (dupilumab injection). Monday-Friday, 8 am - 9 pm ETto DUPIXENT MyWay at 1-844-387-9370. 0156 Past Update: March 2023 DUP. Registered nurses are also available to speak with eligible patients about DUPIXENT. Tell your healthcare provider about any new or worsening joint symptoms. Nationally are Covered for DUPIXENT. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. 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). 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. The majority of DUPIXENT patients with commercial/employer-provided insurance use the DUPIXENT MyWay ® Copay Card. 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 MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. The formulary status tool below can help check DUPIXENT coverage for various plans. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Subcutaneous Solution 100 mg/0. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. 0254 Last Update: February 2023 DUP. 0185 Last Update: November 2022 DUP. 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 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. Program Website : Program Applications and FormsView the possible side effects of DUPIXENT in patients with uncontrolled chronic rhinosinusitis with nasal polyposis. I understand the disclosure to the Alliance will be for the purposes of enrolling me in, and providing certain services through the DUPIXENT MyWay Program, including • to determine if I am eligible to participate in DUPIXENT MyWay coverage assistance programs, patient assistance programs, or otherBy checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. 00. 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. Patient assistance program. 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. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Share your form with others. As far as choosing a better plan with a lower deductible, I don't really have much of a choice. March 27, 2018. The most common side effects include: DUPIXENT MyWay. Depends if your insurance cares that Dupixent myway is paying your deductible. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. a Coverage varies by type and plan. Please see Important Safety Information and Patient Information on. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm 01. PRESCRIBER TO FILL OUT Section 6a. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. ) 2 Prescription InformationDupixent® (dupilumab) approved by FDA as the first and only treatment indicated for prurigo nodularis. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Maximum benefit (2023) = $1,483. These programs and tips can help make your prescription more affordable. 98% of Commercially Insured Patients. DUPIXENT can be used with or without topical corticosteroids. 80). Program possessed one annual maximum from $13,000. S. Program Website : Patient Assistance Applicationsfor DUPIXENT® dupilumab therapy My Information. If you’re the spouse or. It took the price from 2K to 1K. and other countries to treat several diseases driven by type 2 inflammation. 0156 Past Update: March 2023 DUP. 67 mL, 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. 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. Patient Signature _____ If you have questions about the . The formulary status tool below can help check DUPIXENT coverage for various plans. It's like $35k-$40k. Be sure to fill out your enrollment form completely and accurately. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. 09. 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 . A program called Dupixent MyWay is available for this drug. Type text, add images, blackout confidential details, add comments, highlights and more. Dupixent is not intended for episodic use. $125 is the amount Dupixent assistance pays. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. 02. Clip the card and save • Save up to 80% on medications* Tell your healthcare provider about any new or worsening joint symptoms. It should only be given by an adult caregiver in children 6 to 11 years of age. In addition, I agree to notify DUPIXENT MyWay if my insurance situation changes. J Allergy Clin Immunol Pract. 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. Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. Got off of it as soon as I realized it was getting worse with every shot after spacing them out every other month. Nationally are Covered for DUPIXENT. According to the manufacturers, Dupixent can be dosed to a maximum daily dose as indicated below. living with prurigo nodularis are most in need of new treatment options . • DUPIXENT can be stored at room temperature up to 77°F (25°C) up to 14 days. chevron_right. Caring. Coverage varies by type and plan. At one point, I was getting cold sores every 2 to 3 weeks consistently. Copay Card or you wish to discontinue your participation, please contact us. Dupixent MyWay Copay Card. 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). Have commercial insurance, including health insurance. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Monday-Friday, 8 am-9 pm ET. These programs and tips can help make your prescription more affordable. 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. 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. Based on the questions answered above, you are not eligible to register for a new copay card or to activate a copay card. 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). DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. Sign up or activate your card here. After removal from the refrigerator, DUPIXENT must be used within 14 days or discarded. Income at or below: Not Published: Medical expenses can be deducted from reported income:. Biologics and monoclonal antibodies (mabs) for atopic dermatitisVO: DUPIXENT® (dupilumab) is a prescription medicine used to treat people aged 6 years and older with moderate-to-severe atopic dermatitis (eczema) that is not well controlled with prescription therapies used on the skin (topical), or who cannot use topical therapies. 1. Form more information phone: 844-387-4936 or Visit website Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. A group of skin conditions characterized by skin inflammation, rash, and itch. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. 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. ) Please refer to Section 8, Patient Certifications, for. The most common side effects include: DUPIXENT MyWay. 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. 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 (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. Edit your dupixent myway enrollment form online. THIS IS NOT INSURANCE. I understand that. Experience: Been on Dupixent since May 15, 2017. 23. Section 5a. . So, let's just pretend the total cost is $1,000/month. Patient is responsible for any out-of-pocket amounts that exceed the program limit. Income at or below: Not Published: Medical expenses can be. What it is used for. 22. Each time you fill your DUPIXENT prescription, please ensure your. Learn how DUPIXENT helped treat children 6 to 11 years old with their moderate-to-severe asthma. I’m Laurie. 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. 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. 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. 34 milliliters 200 mg/1. for DUPIXENT® dupilumab therapy My Information. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. ) I agree that Regeneron Pharmaceuticals, Inc. Rx: DUPIXENT® (dupilumab) (100 mg/0. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. 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). 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. Dupixent Myway . ) 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). 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. 89 and -1. financial assistance for eligible patients, provide one-on-one nursing. Do not store DUPIXENT pre-filled syringes at room temperatures more than 77°F (25°C) Do not keep DUPIXENT at room temperature. Check the liquid in the prefilled pen or syringe. Get a Quick Start. DUPIXENT® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. I give supplemental injection training to the patient and the patient’s caregiver. If you are a New York prescriber, please use an original New York State prescription form. I also have the dupixent myway card that covers a total of $13,000 for the year. My wife is on Dupixent, and has the MyWay card which allows up to $13,000/year. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Sign it in a few clicks. I’m a registered nurse with DUPIXENT MyWay. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. . A quantity of Dupixent will be considered medically necessary if the above criteria are met, as indicated in the table below:. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. 00 per injection. They will begin the benefits investigation and inform your office of the next steps. ) 2 Prescription InformationDUPIXENT is not a steroid. Most do, some don't. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. ) Please refer to Section 8, Patient Certifications, for. Since 2017, Dupixent has increased in price by 13%. 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. Robocalls increase diabetic retinopathy screenings in low-income patients. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. 67 mL Dupixent subcutaneous solution from $3,787. 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. Serious adverse reactions may occur. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. 02. 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. 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. Learn how DUPIXENT® (dupilumab), the first FDA-approved weekly injectable biologic treatment for eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg) targets a source of inflammation, which contributes to EoE. 00 per injection. financial assistance for eligible patients, provide one-on-one nursing support, and more. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. 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. 71 for Dupixent compared to 0. 89 and -1. For more information, call 1-844-DUPIXENT. 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. Continuation in the DUPIXENT MyWay Patient Assistance Program is conditioned upon timely verification of income. Please see accompanying full Prescribing InformationTell us about yourself. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. 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. Some people do injections every 3 weeks, which could stretch that copay card out longer. LASTING CHANGE IS ACHIEVABLE. 14 mL, or 300 mg/2 mL) Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. You can email or print the enrollment forms below. 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. Enroll now to receive emails and resources designed to help patients, caregivers and information seekers through the DUPIXENT® (dupilumab) treatment journey. • Store DUPIXENT in the original carton to protect from light. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. 1 Reactions. 23. Serious adverse reactions may. That is good, because I was quoted 1400+ a month by my Medicare D provider. PRESCRIBER TO FILL OUT Section 6a. This DUPIXENT Pre-filled Pen is a single-dose device. 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. Serious side effects can occur. Quantity Limits: Dupixent: 200 mg/1. comfysnail • 1 yr. 14 mL, or 300 mg/2 mL)The average cash price for a 30-day supply of Dupixent is $5,298. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm01.