Program Enrollment Is Quick and Easy for Patients/Caregivers
Patients must be enrolled to access all IPSEN CARES support offerings.
STEP
1
Patient and HCPs can fill out the IPSEN CARES Enrollment Form at the office. The form can either be filled out online and then submitted electronically, or it can be printed and then faxed to IPSEN CARES.
STEP
2
Once a completed Enrollment Form is received, an IPSEN CARES Patient Access Specialist will conduct a benefits verification to review the patient’s out-of-pocket costs associated with the Ipsen medication. Additional support offerings for which the patient may be eligible will be discussed at that time.
IPSEN CARES Enrollment Form
Patient Authorization
Patients are required to sign the Onivyde Patient Authorization Form every 3 years or sooner if required by state law to give the Patient Access Specialists at IPSEN CARES permission to access the patient’s personal health information in order to help with treatment. The form can be signed and submitted online, or by downloadable PDF, which must be printed, filled out, signed, and faxed.
IPSEN CARES Patient Authorization Form
Help With Copays?
Check for copay coverage. Considering that some patients need financial assistance, our copay assistance programs may help eligible* patients with the cost of their treatment.
The Onivyde Copay Assistance Program for eligible, commercially insured patients is available by enrolling in IPSEN CARES. Here is the key information:
- Patients may pay as little as $0 per prescription
- For patients utilizing the Medical Benefit, we will send details for claims processing on behalf of the patient directly to the doctor’s office
- For patients who are eligible for government health benefits (eg, Medicare, Medicaid, TRICARE), IPSEN CARES may be able to offer the contact information for independent nonprofit foundations that may be able to offer financial assistance
IPSEN CARES Copay Assistance Flashcard
*Patient Eligibility & Terms and Conditions: Patients are not eligible for copay assistance through IPSEN CARES® if they are enrolled in any state or federally funded programs for which drug prescriptions or coverage could be paid in part or in full, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE (collectively, “Government Programs”), or where prohibited by law. Patients residing in Massachusetts, Minnesota, or Rhode Island can only receive assistance with the cost of Ipsen products but not the cost of related medical services (injection). Patients receiving assistance through another assistance program or foundation, free trial, or other similar offer or program, are not eligible for the copay assistance program during the current enrollment year.
For patients with commercial insurance, the maximum copay benefit amount per prescription is an amount equal to the difference between the annual maximum copay benefit of $20,000 and the total amount of copay benefit provided to the patient in the ONIVYDE® Copay Program.
Patient or guardian is responsible for reporting receipt of copay savings benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled through the program, as may be required. Additionally, patients may not submit any benefit provided by this program for reimbursement through a Flexible Spending Account, Health Savings Account, or Health Reimbursement Account. Ipsen reserves the right to rescind, revoke, or amend these offers without notice at any time. Ipsen and/or CoverMyMeds, are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Data related to patient participation may be collected, analyzed, and shared with Ipsen for market research and other purposes related to assessing the program. Data shared with Ipsen will be de-identified, meaning it will not identify the patient. Void outside of the United States and its territories or where prohibited by law, taxed, or restricted. This program is not health insurance. No other purchase is necessary.
