Want to be a part of the DUPIXENT MyWay® Ambassador Program? Fill out this self-nomination form to see if you qualify. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may payable as little while $0* copay per fill by DUPIXENT. 10 for placebo; difference between Dupixent and placebo: -2. Fill out sections 5a and 5b completely to determine patient eligibility. you offering to give them $170 they assumed you didn’t want to bother contacting dupixent myway. r/eczema • I wish there was an eczema simulator so others could feel what we do when they say “don’t. It's like $35k-$40k. So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. Serious side effects can occur. 8K subscribers in the eczeMABs community. Type text, add images, blackout confidential details, add comments, highlights and more. 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. You must also meet certain household income eligibility requirements as outlined below: 48 States and DC. If you still have questions, you can speak with a DUPIXENT MyWay or request to join the program over the phone. If I am completing Section 5b, I authorize for my commercially insured patient one. 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. financial assistance for eligible patients, provide one-on-one nursing support, and more. Eligible patients will receive their cards by email. Ways to save on Dupixent. After that, it is taken as 1 injection every 2 weeks or every 4 weeks, depending on your age and weight. I suppose it doesn't really matter now. You have to game the system instead of trying to get full coverage. 2 cartons. 34 milliliters 200 mg/1. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. For more informational, page 1‑844‑DUPIXENT (1-844-387-4936), option. 02. 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. SINCE 2017, ≈253,000 PATIENTS HAVE FILLED AT LEAST 1 DUPIXENT PRESCRIPTION b,c. Learn about the DUPIXENT® (dupilumab) mechanism of action inhibiting IL-4 and IL-13 signaling in appropriate asthma patients. S. Dupilumab. My wife is on Dupixent, and has the MyWay card which allows up to $13,000/year. Serious side effects can occur. For more information, dial 1‑844‑DUPIXENT( 1-844-387-4936 ), option 1. Please see Important Safety Information and full PI on website. I just started this week so I look forward to seeing the results. DUPIXENT® ® 1-844-387-9370 or Document Drop at (code: 8443879370) In adults and children 6 years and older, your initial dose of DUPIXENT is 2 injections under the skin (subcutaneous injection) at different injection sites. Serious adverse reactions may occur. Type text, add images, blackout confidential details, add comments, highlights and more. 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. $3,645. , Sanofi US, and their affiliates and agents (together, the “Alliance”) may verifyBy checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. Refrigerate it at 36 °F to 46 °F. When I was very young, I knew that I wanted to be a nurse. 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. You may be able to lower your total cost by filling a greater quantity at one time. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Serious side effects can occur. The Dupixent pre-filled syringe is available in the following strengths: 100 mg per 0. Dupixent has been studied in more than 8,000 patients ages 6 years and older across more than 40 clinical trials. “Eczema otherwise unspecified” is not indicated for Dupixent. To enroll or obtain information call 1-877-311. 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 . I understand that DUPIXENT MyWay may revise, change, or terminate any program services at any time without notice to me. Coverage varies by type and plan. ago It is actually not a change in the myway program. It was a process to get into the patient assist program. Oct 26, 2022 · Dupixent MyWay Program Enrollment Form for Allergists (AD, Asthma, CRSwNP). Fill a 90-Day Supply to Save. THIS IS NOT INSURANCE. Support. ®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. I’ve been with DUPIXENT MyWay since the very beginning. 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. 2 cartons. The most common side effects include: DUPIXENT MyWay. Dupixent side effects. 71 for Dupixent compared to 0. 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. 22. Susie16 Oct 15, 2023 • 9:37 PM. Help educate and inspire other patients trying to manage their conditions by sharing your treatment journey through the DUPIXENT MyWay® Ambassador Program. Enroll now to receive emails and resources designed to help patients, caregivers and information seekers through the DUPIXENT® (dupilumab) treatment journey. If requested, I agree to provide proof of income within thirty (30) days of the request. 80). 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. March 27, 2018. DUPIXENT MyWay team will research each patient’s situation and determine eligibility. 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. 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. 00, but I do have some money invested. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. 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. 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. ( 1-844-387-4936 ), option 1. See All. 00 copay. 01. Household Size. 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. Needed additional leadership equipped the enrollment process? Contact your section accessories dedicated or call DUPIXENT MyWay. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. Rx: DUPIXENT® (dupilumab) (100 mg/0. What it is used for. How many people live in your household? Please refer to Section 8, Patient Certifications, for additional information about the Patient Assistance Program. For more information, dial 1‑844‑DUPIXENT ( 1-844-387-4936 ), option 1 Monday-Friday, 8 am - 9 pm ET. 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). DUPIXENT should not be stored above 77 °F (25 °C). Check your eligibility for the DUPIXENT MyWay® Copay Card that may help cover the out-of-pocket cost of DUPIXENT® (dupilumab) for eligible patients. TEL: 844-387-4936 FAX: 844-387-9370: Languages Spoken: English, Spanish, Others By Translation Service. 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. Call 1-844-387-4936 SUMIT COMPLETED PAGES 1 2 Fax: 1-844-387-9370 MF, 8am9pm ET Document Drop: (code: 8443879370) Patient Name DO / / Prescriber Name Prescriber AddressDupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 14 mL, or 300 mg/2 mL)The Dupixent MyWay program is not available to medicare patients. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus. 74 (2023), plus an amount based on how much you. Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. I have read and agree to the Income Verification included in Section 8 on page 5. 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® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. Fill a 90-Day Supply to Save. Dupixent is not intended for episodic use. Do you think that will hurt my chances of qualifying? I know my prescription drug costs are high enough. ithdrawal of this Authoriation will end my participation in the DUPIXENT MyWay Program and will not aect any disclosure of My Information ased on this Authoriation made efore my reuest is received and processed y my ealthcare Providers, ealth Insurers, and Specialty Pharmacies. The DUPIXENT MyWay team can research each patient's situation and determine eligibility. Regeneron and Sanofi are committed to helping patients in the U. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. I know people who make six figures on a joint income and still use MyWay. Household Income Required if enrolling in the DUPIXENT MyWay Patient Assistance Program. For more information, call 1-844-DUPIXENT. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not affect any disclosure of My Information based on this Authorization made before my request is received and processed by 1‑844‑DUPIXENT 1-844-387-4936. -The MyWay forms themselves changed to a new revision and had to be resubmitted by my doctor -The revised new form needed me to resign then over the phone. 17 and 0. The patient must then take the following actions:I just got approved for dupixent this week however the copay is 3,000$ a month! The dupixent my way program only covers up to 13k or something like that. Option 1- you have to meet your deductible without Dupixent myway. Eczema. Eligible patients will receive their cards by email. Learn how DUPIXENT® (dupilumab) works as the first and only FDA-approved treatment for prurigo nodularis (PN) in adults aged 18 years and older. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Program Website : Program Applications and FormsView the possible side effects of DUPIXENT in patients with uncontrolled chronic rhinosinusitis with nasal polyposis. Please see. Dupixent will run about $3000 per month with my insurance until my maximum is met. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 14 mL, or 300 mg/2 mL)My insurance provider covers 85% and our Canadian version of 'MyWay' pays the remainder. The formulary status tool below can help check DUPIXENT coverage for various plans. Insurance Information Insurance? Yes No If yes, is it Medicare Part D? Primary insurance name Secondary insurance nameDupixent myway income limits 2022; where to buy authentic kf94 masks;. Serious side effects can occur. 5. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. Enrolled patients receive: One-on-one support from our DUPIXENT MyWay support team; Help understanding insurance coverage; Financial assistance (for eligible patients only) Help. Depends if your insurance cares that Dupixent myway is paying your deductible. 14 ml, 300 mg/2 ml: Asthma, atopic dermatitis: 3 syringes for the first 28 days. Also if your insurance does cover,Dupixent offers a co-pay card that. The Dupixent MyWay program is not available to medicare patients. Have commercial insurance, including health insurance. It contains 300 mg of DUPIXENT for injection under the skin (subcutaneous injection). Also, make sure to store the DUPIXENT MyWay phone number in your phone’s contacts so you. You don’t have to put your life on hold to fit your dosing schedule. Manufacturer Coupon. DUPIXENT can be used with or without topical corticosteroids. And very recently got laid off due to Covid-19. I'm "only" 61 now though on Dupixent MyWay copay help. QUEST (12+ years) DUPIXENT offers rapid breathing relief patients can feel as early as Week 2. DUPIXENT® and DUPIXENT MyWay® are entered commercial of Sanofi Biotechnological. Patient Signature _____ If you have questions about the . 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. for reimbursement to any payer, including Medicare and Medicaid; and no free product may be sold, traded, or distributed for sale. Patient and Co-pay Assistance: DUPIXENT MyWay helps eligible patients get access to therapy whether they are uninsured, lack. 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. ) 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). 23. (Includes salary/wages, Social Security income, unemployment insurance benefits, disability income, any other income for the household. 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. DUPIXENT MyWay at PO Bo 22012, Charlotte, NC 2222 a 1--37-9370. 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. They will begin the benefits investigation and inform your office of the next steps. The specialty pharmacy is responsible for securing coverage on my patient’s behalf. Rx: DUPIXENT® (dupilumab) (100 mg/0. Dupixent significantly reduced itch and skin lesions compared to placebo in direct-to-Phase. I've been on Dupixent for over 2 years now and it has been such a great experience keeping my eczema under control. Sign up for the DUPIXENT MyWay® mentor program for adults with uncontrolled chronic rhinosinusitis with nasal polyposis that is associated with type 2 inflammation. By checking the box, I acknowledge DUPIXENT MyWay will not conduct a benefits verification. 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. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. Dupixent MyWay pays the $500 copay. Fill out sections 5a and 5b completely to determine patient eligibility. 67 mL, 200 mg/1. DUPIXENT MyWay. I. 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). So, how can you save? Manufacturer Sanofi offers Dupixent MyWay, a patient support program. Serious side effects can occur. 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. About Dupixent. 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. Rx: DUPIXENT® (dupilumab) (100 mg/0. Program has an annual maximum of $13,000. 0156 Last Update: March 2023 DUP. 14 mL, or 300 mg/2 mL)Section 5a. Declining androgen levels correlated with increased frailty. Pregnancy: A pregnancy exposure registry monitors pregnancy outcomes in women exposed to DUPIXENT during pregnancy. Eligible patients covered by commercial health insurance may pay as little as a $0 p copay per fill of DUPIXENT. 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. 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). 25%) Taro Pharma patient access. If this is the case, write the preferred specialty pharmacy. Talk one-on-one live with a dedicated Dupixent MyWay Case Manager. In this case Dupixent myway will cover the first 13k, which is probably like 5 months. , Sanofi US, and their affiliates and agents (together, the “Alliance”) may verifyDUPIXENT MyWay Nurse Educators are trained to help provide patients with supplemental injection training either online, over the phone, or in person with a training kit and practice syringe or practice pen. Base amount is $558. 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. Im so stressed out about. Fill out sections 5a and 5b completely to determine patient eligibility. If you don't have insurance at all, the only realistic option is to qualify for income-based help from Dupixent directly. Since 2017, Dupixent has increased in price by 13%. Serious side effects can occur. for DUPIXENT® dupilumab therapy My Information. A program called Dupixent MyWay is available for this drug. 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. DUPIXENT can cause serious side effects, including: The most common side effects in patients with eczema include. In clinical trials, DUPIXENT reduced the. Program Website : Patient Assistance Applicationsfor DUPIXENT® dupilumab therapy My Information. A 68-year-old woman developed generalized joint pain 6 weeks after starting Dupixent. Patient is responsible for any out-of-pocket amounts that exceed the program limit. 1kg over one year – the amount of weight gained ranged from 0. Serious adverse reactions may. Get a Quick Start. 12. Thus, the member is now $500 from hitting his deductible and $1500 from hitting his out-of-pocket maximum. In an open-label extension study, the long-term safety profile of DUPIXENT ± TCS in pediatric patients observed through Week 52 was consistent with that seen in adults with. ®DUPIXENT (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. 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. • Store DUPIXENT in the original carton to protect from light. 03. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. 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. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. 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). 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. 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. 99% of commercial patients (6+ months of age) nationally are covered for DUPIXENT. financial assistance for eligible patients, provide one-on-one nursing. These programs and tips can help make your prescription more affordable. ) 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. I have a $40 copay but I got the dupixent my way copay card its free for me. Patient assistance program. DUPIXENT can be used with or without topical corticosteroids. Patients in each age group saw improved lung function in as little as 2 weeks. Since MyWay covers 13,000 a year, that will count towards your deductible. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. Edit your dupixent myway enrollment form online. with household income, to qualify. If you don’t have health insurance, talk. 1‑844‑DUPIXENT 1-844-387-4936. ENROLLMENT FORMDUPIXENT is a form of medicine called a biologic that targets Type 2 inflammation, an underlying cause of nasal polyps. For more information, dial 1. This medicine should be given by a caregiver in children 6 months to less than 12 years of age. chevron_right. Dupixent MyWay Program This program provides brand name medications at no or low cost: Provided by: Sanofi and Regeneron Pharmaceuticals, Inc. DUPIXENT is a biologic and can help reduce your patients' use of systemic corticosteroids. With the DUPIXENT MyWay Copay Card, eligible, commercially insured patients may pay as little as $0* copay per fill of DUPIXENT. 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 . Learn why DUPIXENT® (dupilumab) may be an. 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. DUPIXENT can be used with or without topical corticosteroids. Please see accompanying full Prescribing InformationTell us about yourself. How to fill out dupixent reimbursement: 01. 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. ) Please refer to Section 8, Patient Certifications, for. Your healthcare provider may stop DUPIXENT if you develop joint symptoms. 38]). Do NOT shakeConoce las dos opciones de administración disponibles: jeringa precargada de 200 mg y 300 mg, y pluma precargada de 200 mg y 300 mg (para edades de 12 años o más), y revisa cómo inyectar DUPIXENT® (dupilumab), un medicamento para inyección subcutánea, de venta con receta, para el eczema moderado a grave en adultos y niños de 6 meses o más. com. Option 1- you have to meet your deductible without Dupixent myway. For more information, call 1-844-DUPIXENT. 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. Copay Card or you wish to discontinue your participation, please contact us. Serious side. Your experience with DUPIXENT is unique, and sharing your journey can inspire and empower people facing similar challenges. Patients will need on hit the eligibility benchmark, including household income, to qualify. So, even with a "prior authorization" and a "formulary override", the cost to me is $2900 per month, or about $1450. Withdrawal of this Authorization will end my participation in the DUPIXENT MyWay Program and will not ENROLL. Eligible clients will receive their cards by email. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. 0254 Last Update: February 2023 DUP. Patient to Fill Out. Prior authorization and appeals. Most do, some don't. 0156 Past Update: March 2023 DUP. 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. If I am completing Section 5b, I authorize for my commercially insured patient one. Please see accompanying full Prescribing Information. Lancet. DUPIXENT has been FDA approved for use in adults with uncontrolled moderate-to-severe eczema since 2017. $4,930. 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. a $85. Dupixent changed my life completely. DUPIXENT® is a prescription medicine FDA-approved to treat five conditions. DUPIXENT MyWay® is a patient support program that can help with the enrollment process, offer. 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. Tips. DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. My doctor gave me a copay card to cover mine. a FDA approved since 2017 for adults, 2019 for adolescents (aged 12‑17 years), 2020 for children (aged 6-11 years), and 2022 for infants to preschoolers (aged 6 months-5 years) with uncontrolled moderate‑to‑severe atopic dermatitis. It will also depend on how much you have. Required if enrolling in the DUPIXENT MyWay. Maximum benefit (2023) = $1,483. Dedicated Dupixent MyWay Case Managers can explain information related to Dupixent. The DUPIXENT MyWay program also provides useful tools and resources to help you stay on track with your treatment. I consent to DUPIXENT MyWay contacting me by fax, mail, or email to provide additional information about DUPIXENT injection or DUPIXENT MyWay. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. ) 2 Prescription InformationIn adults and children 6 years and older, your initial dose of DUPIXENT is 2 injections under the skin (subcutaneous injection) at different injection sites. 14 mL, or 300 mg/2 mL)The average cash price for a 30-day supply of Dupixent is $5,298. The DUPIXENT MyWay team will research each patient’s situation and determine eligibility. . I found the carnivore diet helps immensely for autoimmune issues. Fill out sections 5a and 5b completely to determine patient eligibility. 09. Get a Quick Start. for DUPIXENT® dupilumab therapy My Information. Draw your signature, type it, upload its image, or use your mobile device as a signature pad. was not paid in whole or in part by Medicare, Medicaid, or any federal or state programs. 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. Dupixent® should be given by or under the supervision of an adult in children 12 years of age and older. living with prurigo nodularis. For more information and to find out if you’re eligible for support, call 844-DUPIXENT (844-387-4936) or visit the program website. For more information, dial 1‑844‑DUPIXENT 1-844-387-4936 Monday-Friday, 8 am-9 pm ET. 22. They are a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam, or the USVI. Check the liquid in the prefilled pen or syringe. will not conduct a benefits verification. Click Tap to Learn More In an open-label extension study, the long-term safety profile of DUPIXENT ± TCS in pediatric patients observed through Week 52 was consistent with that seen in adults with atopic dermatitis, with hand-foot-and-mouth disease and skin papilloma (incidence ≥2%) reported in patients 6 months to 5 years of age. I’m Laurie. 1. Learn about DUPIXENT® (dupilumab) for moderate-to-severe asthma treatment. Dupixent MyWay pays the $500 copay. 89 and -1. Please see Important Safety Information and Prescribing Information and Patient Information on website. if speciality. 23. any time by mailing or faxing a written request to DUPIXENT MyWay at PO Box 220128, Charlotte, NC 28222; Fax: 1-844-387-9370. DUPIXENT® is a subcutaneous injectable prescription medicine for adults and children aged 6 months & older with uncontrolled, moderate-to-severe. 23. Please see Important Safety Information and Prescribing Information and Patient Information on website. For more information, call 1. 00 per injection. 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. DUPIXENT MyWay Ambassador. DUPIXENT . S. including household income, to qualify. Dupixent MyWay Program Dupixent (dupilumab injection). THE DUPIXENT MyWay PROGRAM. And, if you're eligible, you can sign up and receive your card today. Check the liquid in the prefilled pen or syringe. $0 is the amount you pay. financial assistance for eligible patients, provide one-on-one nursing support, and more. If you are a New York prescriber, please use an original New York State prescription form. g. Each time you fill your DUPIXENT prescription, please ensure your. . Dupixent inhibits the overactive signaling of interleukin-4 (IL-4) and. out and fax back to DUPIXENT MyWay at 1-844-387-9370 • You or your specialist can call 1-844-DUPIXEN(T), option 1 • Providing your email address allows DUPIXENT MyWay to give you more support resources about DUPIXENT. Rx: DUPIXENT® (dupilumab) (100 mg/0. 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. a ®® ® 1-844-387-9370 or Document Drop at (code: 8443879370) or Document Drop at (code: 8443879370) am pm600 mg (two 300 mg injections) 300 mg Q4W : 30 to less than 60 kg ; 400 mg (two 200 mg injections) 200 mg Q2W : 60 kg or more : 600 mg (two 300 mg injections)Enrollment Form FOR DERMATOLOGISTS Complete the entire form and submit pages 1-2 to DUPIXENT MyWay® via fax at 1-844-387-9370 or Document Drop at (code: 8443879370) For assistance, call 1-844-DUPIXEN(T) (1-844-387-4936) Option 1, Monday–Friday, 8 am–9 pm ET Patient Name DOB Prescriber. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. 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. who are prescribed Dupixent gain access to the medicine and receive the support they may need with the DUPIXENT MyWay ® program. DUPIXENT MyWay® is a patient support program designed to assist with access to DUPIXENT® (dupilumab) while providing useful tools and resources. (2 of 3) Patient signature/Legal representative if patient is <18 years Date Section 2. DUPIXENT MyWay® is a patient support program designed to help you get access to DUPIXENT and help eligible patients cover the out-of-pocket costs of DUPIXENT.