For more information, call 1-844-DUPIXENT ( 1-844-387-4936) option 1. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. Decreased exacerbations and/or improvement in symptoms 2. Serious side effects can occur. Some Medicare plans may help cover the cost of mail-order drugs. a Coverage varies by type and plan. for DUPIXENT® dupilumab therapy My Information. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help. Quantity Limits: Dupixent: 200 mg/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. 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. It's like $35k-$40k. Prurigo Nodularis: The most common adverse reactions (incidence ≥2%) are nasopharyngitis, conjunctivitis, herpes infection, dizziness, myalgia, and diarrhea. 02. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. Since 2018, DUPIXENT has been prescribed to over 100,000 asthma patients in the US. Do not store DUPIXENT pre-filled syringes at room temperatures more than 77°F (25°C) Do not keep DUPIXENT at room temperature. b Data as of January 2023. 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. Dupixent will run about $3000 per month with my insurance until my maximum is met. 10 for placebo; difference between Dupixent and placebo: -2. 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. 01. Maximum benefit (2023) = $1,483. 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. 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. 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. 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). 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. Sign up or activate your card here. Complete the entire form and submit pages 1-3 to DUPIXENT MyWay® via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm ET Enrollment Form FOR ALLERGISTSThe price you pay for Dupixent can vary. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. 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. Some people do injections every 3 weeks, which could stretch that copay card out longer. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. The formulary status tool below can help check DUPIXENT coverage for various plans. Dedicated Dupixent MyWay Case Managers can explain information related to Dupixent. . I suppose it doesn't really matter now. 02. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. 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 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. g. Dupixent MyWay pays the $500 copay. 0kg. I just started this week so I look forward to seeing the results. If requested, I agree to provide proof of income within thirty (30) days of the request. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. Allow the medicine to warm to room temperature for 30 or 45 minutes before using it. The DUPIXENT MyWay team will research each patient's situation and determine eligibility. Every enrolled patient is assigned a phone-based DUPIXENT MyWay® Nurse Educator, who takes a patient-centric approach to providing tools, support resources, and education throughout the patient’s treatment journey. ) 2 Prescription InformationDUPIXENT is not a steroid. DUPIXENT® (dupilumab) is indicated as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. 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® (dupilumab) approved by FDA as the first and only treatment indicated for prurigo nodularis Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. I also enrolled in the dupixent my way program and my ambassador told me that as long as you don’t make $100,000 a year you qualify for the program to get dupixent free for a year. Continuation in the program is conditioned upon timely verification of income. I wanted to go out and make a difference and help people. 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. 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. See All. 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. Dupilumab. for DUPIXENT® dupilumab therapy My Information. You don’t have to put your life on hold to fit your dosing schedule. 22. Please see accompanying full Prescribing Information. 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. Fill out sections 5a and 5b completely to determine patient eligibility. 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. $0!!!!! On April 6 I sent them income paperwork and my year to date prescription invoices. Please see. 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. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. 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. Clip the card and save • Save up to 80% on medications*Tell your healthcare provider about any new or worsening joint symptoms. Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. including household income, to qualify. Program has an annual maximum of $13,000. It temporarily provides eligible patients DUPIXENT at no cost, subject to program terms and conditions. March 27, 2018. and other countries to treat several diseases driven by type 2 inflammation. The most common side effects include: DUPIXENT MyWay. Ways to save on Dupixent. If you don't have insurance at all, the only realistic option is to qualify for income-based help from Dupixent directly. DUPIXENT® (dupilumab) is a prescription medicine FDA-approved to treat five conditions. That is what I am in the middle of. 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. Eczema. ago. XXXX 00/0000 b y: A B C c o m pa n y, I n c. If you are a New York prescriber, please use an original New York State prescription form. 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. At one point, I was getting cold sores every 2 to 3 weeks consistently. They will begin the benefits investigation and inform your office of the next steps. ) Please refer to Section 8, Patient Certifications, for. It's like $35k-$40k. 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. At that point we will owe 20% of the cost of the medication, which adds up to just under $700/month. Dupixent side effects. 14 mL, or 300 mg/2 mL)My insurance provider covers 85% and our Canadian version of 'MyWay' pays the remainder. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. 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 MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. For any questions or concerns, or to report side effects with a Sanofi and Regeneron product while enrolled in DUPIXENT MyWay®, please contact 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm Eastern time. I also have the dupixent myway card that covers a total of $13,000 for the year. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. Applies to: Dupixent Number of uses: per prescription per year. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Throw away (dispose of) any DUPIXENT that has been left at room temperature for longer than 14 days. 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. It may be covered by your Medicare or insurance plan. Have commercial insurance, including health insurance. Sanofi and Regeneron are committed to helping patients in the U. Check the liquid in the prefilled pen or syringe. Share your form with others. Please see. Monday-Friday, 8 am-9 pm ET. 14 mL, or 300 mg/2 mL)The Dupixent MyWay program is not available to medicare patients. 1-844-387-4936 (toll free) Monday - Friday, 8AM - 9PM (ET) Multilingual options available. DUPIXENT is taken by injection under the skin (subcutaneous injection) once every two weeks. 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). Approximately 72% of the total FEV 1 improvement (470 mL improvement at Week 52 from baseline FEV 1 of 1. ) Please refer to Section 8, Patient Certifications, for. DUPIXENT is not a steroid or immunosuppressant; it is a prescription biologic medicine given under the skin (subcutaneous injection). DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. You can email or print the enrollment forms below. Please see Important Safety Information and Patient Information on. Compare . 01. Dupixent will run about $3000 per month with my insurance until my maximum is met. 67 mL, 200 mg/1. 09. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase 3 program consisting of two pivotal trials. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. This year the program seems to have changed, requiring a separate 'copay card' with an annual limit of $13,000. DUPIXENT MyWay provides prior authorization and appeals information you may need, as well as helpful examples and guides to assist in obtaining coverage for DUPIXENT. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. Although you are not eligible, you can sign up DUPIXENT MyWay. If I am completing Section 5b, I authorize for my commercially insured patient one. 0156 Past Update: March 2023 DUP. 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. For more information, please call 1-844-DUPIXENT (1-844-387-4936) or visit . DUPIXENT MyWay®. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. 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 . You may be eligibility on the DUPIXENT MyWay Copay Card if you:DUPIXENT MyWay Copay Card if you:Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. 14 mL, or 300 mg/2 mL)Section 5a. I'm "only" 61 now though on Dupixent MyWay copay help. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. Appears that my out of pocket maximum will be $8000 through insurance. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. If I am completing Section 5b, I authorize for my commercially insured patient one. For more information or to enroll in the patient support program, contact us at: 1‑844‑DUPIXENT. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. Option 1- you have to meet your deductible without Dupixent myway. 14 mL, or 300 mg/2 mL)The average cash price for a 30-day supply of Dupixent is $5,298. I don't know what medical issues your son is having, but it's likey autoimmune issues. Base amount is $558. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. You can email or print the enrollment forms below. Just got the fun news that I will need to pay $2,700 for a monthly dose of Dupixent. _____ What is your total annual household income? _____ (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Continuation in the DUPIXENT MyWay Patient Assistance Program is conditioned upon timely verification of income. PRESCRIBER TO FILL OUT Section 6a. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older, with uncontrolled, moderate-to-severe eczema (atopic dermatitis). 14 ml, 300 mg/2 ml: Asthma, atopic dermatitis: 3 syringes for the first 28 days. 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. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. With of DUPIXENT MyWay Copay Card, right, commercially insured patients might pay as little as $0* copay per fill of DUPIXENT. Monday-Friday, 8 am-9 pm ET. The DUPIXENT MyWay patient support program is here to help you at every step of your DUPIXENT treatment journey. financial assistance for eligible patients, provide one-on-one nursing support, and more. DUPIXENT MyWay Appeal Specialists can help provide support throughout the appeal process. I give supplemental injection training to the patient and the patient’s caregiver. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. The DUPIXENT MyWay program also provides useful tools and resources to help you stay on track with your treatment. Dupixent MyWay ™ will help eligible patients who are uninsured, lack coverage, or need assistance with their out-of-pocket costs. S. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. I know people who make six figures on a joint income and still use MyWay. DUPIXENT can be used with or without topical corticosteroids. 67 mL, 200 mg/1. Susie16 Oct 15, 2023 • 9:37 PM. For more information, dial 1‑844‑DUPIXENT ( 1-844-387-4936 ), option 1 Monday-Friday, 8 am - 9 pm ET. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. Even when using the Copay Card, that would cover only cover 4 months worth, and would not go towards my deductible, totaling about. With MyWay, I get the year for free. 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. 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. But either way, after you or Dupixent myway meets your deductible, it should be free to you. 67 mL, 200 mg/1. Get ongoing, personalized nursing support; help scheduling monthly prescription refills and deliveries; and in-home, in-office, or online supplemental injection training. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. A group of skin conditions characterized by skin inflammation, rash, and itch. Coverage varies by. Serious adverse reactions may occur. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. Biologic Drug: Biologic drugs are made from living cells and are often expensive. 23. 28. 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. 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. It may be covered by your Medicare or insurance plan. Social Security income, unemployment insurance benefits, disability income, any other income for the household. 12. 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). living with prurigo nodularis are most in need of new treatment options . Well at a cost of roughly $3,500/dose which lasts a month, that will all be used up in four months. Be sure to fill out your enrollment form completely and accurately. 0156 Past Update: March 2023 DUP. 23. Fill a 90-Day Supply to Save. From my understanding, the Dupixent MyWay Program pays the $125 since your insurance is covering the rest. Financial criteria for patient assistance. DUPIXENT MyWay. BIN: 020750 RX PCN: NMeds RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. 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. 23. Eligible patients will receive they cards by e-mail. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. 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. 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. 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. DUPIXENT MyWay® Program Taking Dupixent. A 48-year-old man developed left thumb tenderness and bilateral Achilles tendinopathy after 6 weeks of Dupixent. I’m a registered nurse with DUPIXENT MyWay. Griffinej5 • 2 yr. Prior authorization and appeals. I’m Laurie. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Patient Assistance Program. If you don’t have health insurance, talk. DUPIXENT can be used with or without topical corticosteroids. Dupixent (dupilumab) is used to treat certain patients with eczema, asthma, and nasal polyps. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. 01. 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. 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. Support. 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. You have to game the system instead of trying to get full coverage. I pay for it with my insurance and the myway copayment program. Using the drop. 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. 0254 Last Update: February 2023 DUP. The $500 payment counts towards the member’s deductible and out-of-pocket maximum. Each time you fill your DUPIXENT prescription, please ensure your. ®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. For more information, call 1-844-DUPIXEN (T) (1-844-387-4936. The most common side effects include: DUPIXENT MyWay. a FDA approved since 2017 for adults, 2019 for adolescents (aged 12‑17 years), 2020 for children (aged 6-11 years), Patients may be eligible for the DUPIXENT MyWay Copay Card if: They have a DUPIXENT prescription for an FDA-approved condition. Caring. Contact the health plan or DUPIXENT MyWay® to verify coverage for a specific patient. For children aged 6 months to 5 years, it is taken as 1 injection every 4 weeks. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 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. 50 for a single person. Sign up for the DUPIXENT MyWay® mentor program for adults with uncontrolled chronic rhinosinusitis with nasal polyposis that is associated with type 2 inflammation. 22. If you are a New York prescriber, please use an original New York State prescription form. Nationally are Covered for DUPIXENT. 01. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. Dupixent MyWay Program CONTACT INFO: Address:, Phone: 1-844-387-4936: Provider Phone: Fax: 1-844-387-3970: Website: Program Website: ELIGIBILITY Eligibility Info:. 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. Compare . Follow these tips to take DUPIXENT while traveling: Store DUPIXENT in the original carton to protect it from light. 58 for 1. Program possessed one annual maximum from $13,000. At one point, I was getting cold sores every 2 to 3 weeks consistently. S. DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. 01. Program has an annual maximum of $13,000. Not valid for prescriptions paid, in whole or in part, by Medicaid, Medicare, VA, DOD, TRICARE, or. Sign it in a few clicks. Oct 26, 2022 · Dupixent MyWay Program Enrollment Form for Allergists (AD, Asthma, CRSwNP). After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. A program called Dupixent MyWay is available for this drug. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. Since 2017, Dupixent has increased in price by 13%. 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. 17 and 0. I may opt out of receiving Communications, individual support services, including the DUPIXENT MyWay® Copay Card, or opt out of DUPIXENT MyWay® entirely at any time by notifying a representative by telephone at 1-800-633-1610 or by sending a letter to Sanofi US Customer Service P. 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). By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. Fill out sections 5a and 5b completely to determine patient eligibility. Dupixent is an injection under the skin (subcutaneous injection) at different injection sites. a,b a Data on file, Sanofi and Regeneron, US. Section 5a. I wanted to go out and make a difference and help people. . 1-844-DUPIXENT (1-844-387-4936) Topicort (desoximetasone spray 0. ) 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). 14 mL, or 300 mg/2 mL)Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. A case series of 12 people prescribed Dupixent reported an average weight gain of 6. 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. Opinions clash over private equity’s effect on dermatology. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. When I was very young, I knew that I wanted to be a nurse. 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). With and DUPIXENT MyWay Copay Card, eligible, commercially insured care may pay when little as $0* copay by fill the DUPIXENT. 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. 98% of Commercially Insured Patients. Serious side effects can occur. ) I agree that Regeneron Pharmaceuticals, Inc. FUN Documents, MMIT, and Policy Reporter as of July 12, 2023. ) 2 Prescription Informationany 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 MyWay Appeal Specialists can help provide support throughout the appeal process. Learn more about programs for eligible patients who are insured, underinsured, and uninsured. Decreased utilization of rescue medications 3. if speciality. I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. 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. 89 and -1. ®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. 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. Approval represents the second dermatology indication for Dupixent and fifth disease indication overall in the. 0252 Last Update: Feb 2023 DUP. Your office may choose to use a preferred specialty pharmacy to start the benefits investigation. Edit your dupixent myway enrollment form online. Compare monoclonal antibodies. 80). (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Over 80% of insurance plans cover Dupixent, but many have restrictions. 80). With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. Serious adverse reactions may occur. If you don't have insurance at all, the only realistic option is to qualify for income-based help from Dupixent directly. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Please see accompanying full Prescribing InformationTell us about yourself. with household income, to qualify. 3. Boguniewicz M, Alexis AF, Beck LA, et al. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. 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). PRESCRIBER TO FILL OUT Complete the entire form and submit pages 1-2 to ®DUPIXENT MyWay via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) Education and Nurse Support: One-on-one nursing support is available to educate and empower patients to use DUPIXENT as prescribed. Serious side effects can occur. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. DUPIXENT MyWay. Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. 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. 2022;400 (10356):908-919. You may be able to get a 90-day supply of Dupixent. Assistance may be available for patients who do not have insurance. About 75,000 adults in the U. 1-844-DUPIXENT 1-844-387-4936. 00. Dedicated Dupixent MyWay Case Managers can explain information related to Dupixent. 01. 14 mL, or 300 mg/2 mL) Call 1-844-387-4936, Option 1 to contact DUPIXENT MyWay ®. · If the insurer does have a copay accumulator in place: the insurer pays the entire cost of the refill except for $500. Please see accompanying full Prescribing Information. Depends if your insurance cares that Dupixent myway is paying your deductible. Check the liquid in the prefilled pen or syringe. $0 is the amount you pay. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. Dupixent Myway . Serious side. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. This DUPIXENT Pre-filled Pen is a single-dose device. According to the manufacturers, Dupixent can be dosed to a maximum daily dose as indicated below. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. for DUPIXENT® dupilumab therapy My Information. 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. Household Size. 03.