I. Browse the DUPIXENT® (dupilumab) sitemap to help you learn more about eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg) and navigate DUPIXENT. DUPIXENT MyWay Ambassador. 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. 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 team will research each patient’s situation and determine eligibility. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. Since 2017, Dupixent has increased in price by 13%. Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. S. 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. 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. 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. Regeneron and Sanofi are committed to helping patients in the U. A group of skin conditions characterized by skin inflammation, rash, and itch. 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. 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. living with prurigo nodularis. DUPIXENT can be used with or without topical corticosteroids. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. For more information, dial 1-844-DUPIXENT 1-844-387-4936 ), option 5, Monday-Friday, 9 am – 9 pm ET. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. 67 mL, 200 mg/1. ) Please refer to Section 8, Patient Certifications, for. Caring. Since 2017, Dupixent has increased in price by 13%. Please note that you will receive a confirmation fax after sending the form. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. Serious side effects can occur. ago. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. This DUPIXENT Pre-filled Pen is a single-dose device. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Most do, some don't. Your cost may depend on your treatment plan, your insurance coverage (if you have it), and the pharmacy you use. Monday-Friday, 8 am-9 pm ET. A program called Dupixent MyWay is available for this drug. If you don’t have health insurance, talk. Also if your insurance does cover,Dupixent offers a co-pay card that. 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. Hello! Switching insurance this year and need to prepare for increasing costs of dupixent with my new insurance. 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. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help. 74 (2023), plus an amount based on how much you. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. 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. . For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. 17 and 0. But either way, after you or Dupixent myway meets your deductible, it should be free to you. 17 and 0. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. 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. 01. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. 0156 Past Update: March 2023 DUP. Tips. Especially tell your healthcare provider if you. ) Please refer to Section 8, Patient Certifications, for. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. Clip the card and save • Save up to 80% on medications*Tell your healthcare provider about any new or worsening joint symptoms. They never mentioned only covering a. 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 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 (dupilumab) Dupixent FEP Clinical Criteria AND submission of medical records (e. 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. So the nurse told me to fax receipts for year to date prescriptions and last year's income forms (W2, 1099, etc). 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. Subcutaneous Solution 100 mg/0. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. You can email or print the enrollment forms below. THE DUPIXENT MyWay PROGRAM. 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). In this case Dupixent myway will cover the first 13k, which is probably like 5 months. 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 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. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. 01. How many people live in your household? _____ Please refer to. DUPIXENT should not be stored above 77 °F (25 °C). About Dupixent. Appears that my out of pocket maximum will be $8000 through insurance. Just got off the phone with Dupixent My Way. 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. 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. Patients will need on hit the eligibility benchmark, including household income, to qualify. Dupixent will run about $3000 per month with my insurance until my maximum is met. Copay Card or you wish to discontinue your participation, please contact us. Griffinej5 • 2 yr. Coverage varies by type and plan. 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. LEARN ABOUT OUR PATIENT SUPPORT PROGRAM. Injection in children 12 and older should be supervised by an adult. Coverage varies by. Depends if your insurance cares that Dupixent myway is paying your deductible. DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. Dupixent Myway . a,b a Data on file, Sanofi and Regeneron, US. 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. Be sure to fill out your enrollment form completely and accurately. A quantity of Dupixent will be considered medically necessary if the above criteria are met, as indicated in the table below:. Financial criteria for patient assistance. 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. g. 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. Dupixent on a High Deductible Health Plan. Dupixent MyWay ™ will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket costs. Regeneron and Sanofi are committed to helping patients in the U. And very recently got laid off due to Covid-19. Since MyWay covers 13,000 a year, that will count towards your deductible. Eligible clients will receive their cards by email. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. DUPIXENT MyWay. . 2022;400 (10356):908-919. Patient Signature _____ If you have questions about the . Rx: DUPIXENT® (dupilumab) (100 mg/0. Even when using the Copay Card, that would cover only cover 4 months worth, and would not go towards my deductible, totaling about. How many people live in your household? _____ Please refer to. 0252 Last Update: Feb 2023 DUP. Dupixent (dupilamab) Dupixent MyWay patient support program. I’m a registered nurse with DUPIXENT MyWay. Fill out sections 5a and 5b completely to determine patient eligibility. I also have the dupixent myway card that covers a total of $13,000 for the year. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. DUPIXENT MyWay®. It may be covered by your Medicare or insurance plan. The DUPIXENT MyWay nurse connects patients to a variety of considerate resources, including one-on-one nursing product, financial assistance for right patients, and helpful refill and injection reminders. Prurigo Nodularis: The most common adverse reactions (incidence ≥2%) are nasopharyngitis, conjunctivitis, herpes infection, dizziness, myalgia, and diarrhea. Dupixent is not intended for episodic use. Serious side effects can occur. Nationally are Covered for DUPIXENT. You may be able to get a 90-day supply of Dupixent. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. For patients with commercial insurance who are new to DUPIXENT and experiencing a. Copay Card or you wish to discontinue your participation, please contact us. 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. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 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. Once you’ve been prescribed DUPIXENT, your healthcare provider can download the enrollment form, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. On dupixent, Dupilumab, I honestly felt I was in my 60 to 70s+ with joint pains throughout my entire body even into the smallest of joints like fingers. Decreased exacerbations and/or improvement in symptoms 2. 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. 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. The DUPIXENT MyWay team can research each patient’s situation and determine eligibility. 26 [95% CI: 0. Deductible is at $3k out of pocket insurance pays 80% and at $6k insurance pays 100%. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. 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 MyWay Copay Card. chevron_right. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. 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. Type text, add images, blackout confidential details, add comments, highlights and more. Ways to save on Dupixent. DUPIXENT MyWay®. 00 copay. Program Website : Program Applications and Forms will need to meet the eligibility criteria, including household income, to qualify. 6 Submitting a PA request The appeal. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. For me, the side effects didn’t really bother me or have me second guess my decision with Dupixent because my skin was. 67 mL Dupixent subcutaneous solution from $3,787. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. 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. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. 67 mL, 200 mg/1. Continuation in the program is conditioned upon timely verification of income. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. Rx: DUPIXENT® (dupilumab) (100 mg/0. Manufacturer Coupon. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. THE DUPIXENT MyWay COPAY CARD. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older, with uncontrolled, moderate-to-severe eczema (atopic dermatitis). Im so stressed out about. 23. Dupilumab. It is not an immunosuppressant or a steroid. Connect with someone, ask questions, and learn about their experience with DUPIXENT® (dupilumab) treatment. Assistance may be available for patients who do not have insurance. The most common side effects include: DUPIXENT MyWay. 1,000-125=875 $875 is the amount your health insurance pays. DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Maximum benefit (2023) = $1,483. Serious side effects can occur. I have read and agree to the Income Verification included in Section 8 on page 5. 67 mL, 200 mg/1. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. financial assistance for eligible patients, provide one-on-one nursing support, and more. Patient Signature _____ If you have questions about the . Dupixent is currently approved in the U. Susie16 Aug 29, 2023 • 2:03 AM. Your office may choose to use a preferred specialty pharmacy to start the benefits investigation. 23. 23. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. form on DUPIXENT. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. com. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Patient assistance program. 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. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. THE DUPIXENT MyWay PROGRAM. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. Dupixent. 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. Hear real patients stories of life with uncontrolled moderate-to-severe asthma and how discovering DUPIXENT® (dupilumab) impacted their journey. Dupixent MyWay pays the $500 copay. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. It may be covered by your Medicare or insurance plan. Base amount is $558. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials. 03. 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,DUPIXENT has been prescribed to over 50,000 uncontrolled nasal polyp patients and counting! DUPIXENT is the first biologic nasal polyp treatment that’s an alternative to nasal polyp surgery. $3,645. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 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. 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. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit . Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. After that, we will have met our family deductible. The U. Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. It's like $35k-$40k. Monday-Friday, 8 am - 9 pm ETto DUPIXENT MyWay at 1-844-387-9370. At one point, I was getting cold sores every 2 to 3 weeks consistently. 89 and -1. Not valid for prescriptions paid, in whole or in part, by Medicaid, Medicare, VA, DOD, TRICARE, or. for DUPIXENT® dupilumab therapy My Information. If you are a New York prescriber, please use an original New York State. 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. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. PRESCRIBER TO FILL OUT Section 6a. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. QUEST (12+ years) DUPIXENT offers rapid breathing relief patients can feel as early as Week 2. S. Monday-Friday, 8 am-9 pm ET. Just got the fun news that I will need to pay $2,700 for a monthly dose of Dupixent. 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. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. 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. 2 pens of 300mg/2ml. Does anyone know the eligibility process for the dupixent copay assistance? Do they ask for tax forms? Is there an income limit? comments sorted by Best Top New Controversial Q&A Add a Comment More posts you may like. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. 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® (dupilumab), is the first FDA-approved biologic to treat eosinophilic esophagitis (EoE) in patients 12 years and older who weigh at least 88lb (40kg). 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). About 75,000 adults in the U. - Rachel, DUPIXENT Patient Mentor, living with asthma. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. 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. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. DUPIXENT can be used with or without topical corticosteroids. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. Eligible patients will receive they cards by e-mail. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. My doctor gave me a copay card to cover mine. Effective Sept. 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 patients with commercial insurance who are new to DUPIXENT and experiencing a. How to fill out dupixent reimbursement: 01. 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 . Fill out sections 5a and 5b completely to determine patient eligibility. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. For more information, dial 1. 67 mL, 200 mg/1. Self-nominate to become DUPIXENT MyWay® Ambassador, and if selected, you may have opportunities to share your story and offer encouragement to patients and their family members. DUPIXENT can be used with or without topical corticosteroids. Maximum Monthly Gross Income. Advertisement. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). I wanted to go out and make a difference and help people. Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to therapy whether they are uninsured, lack. It will also depend on how much you have. DUPIXENT is taken by injection under the skin (subcutaneous injection) once every two weeks. Serious adverse reactions may occur. In SINUS-24 and SINUS-52, 74% fewer patients required SCS use at Week 52 with DUPIXENT 300 mg Q2W + INCS compared to placebo + INCS (HR: 0. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. DUPIXENT MyWay®. Serious side effects can occur. Program has an annual maximum of $13,000. DUPIXENT MyWay® A program to provide support to patients starting DUPIXENT. It’s a change in how copay assistance and coupons are counted toward your. That is what I am in the middle of. Tell your healthcare provider about any new or worsening joint symptoms. 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). I just got approved thru Dupixent my way for a year of free medication. 0129 Last Update:. Follow these tips to take DUPIXENT while traveling: Store DUPIXENT in the original carton to protect it from light. DUPIXENT MyWay® Program Taking Dupixent. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. Caring. 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). At one point, I was getting cold sores every 2 to 3 weeks consistently. 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. chevron_right. Section 5a. 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 (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. 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. 8K subscribers in the eczeMABs community. You don’t have to put your life on hold to fit your dosing schedule. 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. Serious side effects can occur. 2022;400 (10356):908-919. Rx: DUPIXENT® (dupilumab) (100 mg/0. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. comfysnail • 1 yr. 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. Find videos and downloadable instructions for the two injection administration options available for DUPIXENT® (dupilumab), pre-filled syringe (200 mg or 300 mg) with needle shield for ages 6 months & older, or pre-filled pen (200 mg or 300 mg) for ages 2+ years. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. . 12. 4 ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm 01. Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. THIS IS NOT INSURANCE. Prior authorization and appeals. DUPIXENT . Draw your signature, type it, upload its image, or use your mobile device as a signature pad. Type text, add images, blackout confidential details, add comments, highlights and more. for DUPIXENT® dupilumab therapy My Information. Approximately 72% of the total FEV 1 improvement (470 mL improvement at Week 52 from baseline FEV 1 of 1. If you are a New York prescriber, please use an original New York State prescription form. Form more information phone: 844-387-4936 or Visit website Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. 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. In clinical trials, DUPIXENT reduced the. 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'm guessing this will not be allowed once I'm on Medicare. Patient Assistance Program. 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. 71 for Dupixent compared to 0. 67 mL, 200 mg/1. Patient is responsible for any out-of-pocket amounts that exceed the program limit. Approval represents the second dermatology indication for Dupixent and fifth disease indication overall in the. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. Injection site reactions and eye conditions are the most common side effects reported and, unlike several other biologics, the risk of infection is low. 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. 00. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. I also have the dupixent myway card that covers a total of $13,000 for the year. Section 5a. 2 pens of 300mg/2ml. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. Sign up to connect with a DUPIXENT MyWay® mentor to help patients with Nasal Polyps through their DUPIXENT. 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. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. 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. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Oct 26, 2022 · Dupixent MyWay Program Enrollment Form for Allergists (AD, Asthma, CRSwNP). There is another biologic very similar to Dupixent called Adbry. 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. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay® program. 0156 Past Update: March 2023 DUP. 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. the info from that copay savings card you will give to alliance and they process that after insurance (so the $170 copay they’d cover) which would leave you with $0 copay. 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. 50 for a single person. I’m Laurie. If requested, I agree to provide proof of income within thirty (30) days of the request. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 06 and -1. Access the dupixent reimbursement form either online or through your healthcare provider. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. Serious side. 23. 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. Nationally are Covered for DUPIXENT. Patient to Fill Out. Rx: DUPIXENT® (dupilumab) (100 mg/0. Susie16 Oct 15, 2023 • 9:37 PM. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 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. _____ 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 specialty pharmacy is responsible for securing coverage on my patient’s behalf. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. Dupixent is not intended for episodic use. com, help you fill it out, and fax it back to DUPIXENT MyWay at 1-844-387-9370 • You or your healthcare provider can call 1-844-DUPIXEN(T), option 1 • Providing your email address allows DUPIXENT MyWay to give you more support resources about DUPIXENT HAS YOUR DOCTOR PRESCRIBED DUPIXENT ® (dupilumab)? 14 15. E. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 0252 Last Update: Feb 2023 DUP. S. ) 2 Prescription InformationDUPIXENT is not a steroid. chevron_right. 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. 18, 0. I give supplemental injection training to the patient and the patient’s caregiver.