Hcp.incytecares.com
IncyteCARES for Healthcare Professionals IncyteCARES HCP
WEBFind information and additional resources for patients taking Jakafi® (ruxolitinib), PEMAZYRE® (pemigatinib), ZYNYZ® (retifanlimab-dlwr) & OPZELURA® (ruxolitinib) at IncyteCARES.
Actived: 8 days ago
Support & Resources IncyteCARES for OPZELURA® (ruxolitinib)
WEBOPZELURA is indicated for the topical treatment of nonsegmental vitiligo in adult and pediatric patients 12 years of age and older. Limitations of Use: Use of OPZELURA in combination with therapeutic biologics, other JAK inhibitors, or potent immunosuppressants such as azathioprine or cyclosporine is not recommended.
Patient Assistance Program IncyteCARES for OPZELURA® …
WEBTo Apply: Complete and submit the Prescription and Enrollment Form for OPZELURA. Be sure to check the box for the Patient Assistance Program at the top of page one on the form. You and your patient will need to complete pages 1, 2, and 3 of the form. Proof of income must be provided. Income can be verified electronically if the patient
Commercial Access Program IncyteCARES for OPZELURA® …
WEBWe will follow up with the patient’s health plan at 45 and 90 days post-enrollment to determine if access to OPZELURA may be available and will notify your team accordingly. Commercial Access Program for Nonsegmental Vitiligo Prescription Fulfillment: After a completed enrollment form is submitted, eligible patients may start receiving
Financial Assistance Support for Patients IncyteCARES for Jakafi
WEBJakafi is indicated for treatment of intermediate or high-risk myelofibrosis (MF), including primary MF, post–polycythemia vera MF and post–essential thrombocythemia MF in adults. Jakafi is indicated for treatment of steroid-refractory acute graft-versus-host disease (aGVHD) in adult and pediatric patients 12 years and older.
How to Enroll Your Patients
WEBPatient Terms and Conditions: Update effective as of January 1, 2024. Patients must have minimum out-of-pocket costs of $.01 to redeem this offer. Annual benefit maximum applies, as may other restrictions. Patients will be responsible for any out-of-pocket costs above the maximum annual program benefit. Offer with program member …
Prescription and Enrollment Form for OPZELURA
WEB2 of 4 PRESCRIPTION AND ENROLLMENT FORM OR OPZELURA TO SUBMIT, COMPLETE AND A HIS OR O 1-77-01-384. Provid op h HIPAA uthorizatio ou atien o hei ecords. FOR ASSISTANCE OR ADDITIONAL INFORMATION, CALL 1˛800˛9321720, MONDAY FRIDAY 8 ˙ˆ TO 8 ˇˆ E. By signing this form, you are giving your permission to …
MEDICAL EXCEPTIONS AND PATIENT SUPPORT SERVICES …
WEBIncyte cannot guarantee payment of any claim and providers should contact third-party payers for specific information on their coding, coverage, and payment policies as needed. For questions regarding ZYNYZ reimbursement and access, please call IncyteCARES at 1-855-452-5234 Monday through Friday, 8 am – 8 pm ET.
BILLING AND CODING GUIDE
WEBof care. It is the sole responsibility of the health care provider to select the proper codes and ensure the accuracy of all statements used in seeking coverage and reimbursement for an individual patient. J9345: Injection, retifanlimab-dlwr, 1 mg The permanent J-code for ZYNYZ is effective for claims on or after October 1, 2023.
Copay Savings Program IncyteCARES for OPZELURA® (ruxolitinib)
WEBEligible patients may pay as little as $0* per tube for OPZELURA. *. Eligibility required. For use only with commercial prescription insurance. The card may not be used if the patient is enrolled in a government-funded prescription insurance program or if they pay cash for their prescription. Individual out-of-pocket cost may vary.
Patient Assistance Program IncyteCARES for ZYNYZ® …
WEBImmune-mediated nephritis occurred in 1.6% (7/440) of patients receiving ZYNYZ, including Grade 4 (0.5%), Grade 3 (0.7%), and Grade 2 (0.5%). Nephritis led to permanent discontinuation of ZYNYZ in 0.9% of patients and withholding of ZYNYZ in 1 patient. Systemic corticosteroids were required in 57% (4/7) of patients.
Terms and conditions opzelura HCP.IncyteCARES.com
WEBThe patient is responsible for reporting use of the copay savings card to any commercial insurer, health plan, or other third party that pays for or reimburses any part of the prescription filled using the copay savings card, as may be required. The patient should not use the copay savings card if their insurer or health plan prohibits use of
Sample Letter of Medical Necessity HCP.IncyteCARES
WEBA patient-specific letter of medical necessity will help to explain the physician’s rationale and clinical decision making in choosing a therapy. Please see page 2 for a sample letter of medical necessity with fillable fields that can be customized based on your patient’s medical history and demographic information and then printed.
MEDICAL EXCEPTIONS AND PATIENT SUPPORT SERVICES …
WEBPatients’ health plans may request additional information before approving coverage for treatment. In your efforts to secure ZYNYZ™ (retifanlimab-dlwr) coverage for individual patients, you may need to provide one or more supporting letters. For your reference, we’ve provided template reimbursement letters as well as the
Dose Titration Trial Program for Jakafi® (ruxolitinib)
WEBPO Box 221798 • Charlotte, NC 28222-1798 • Phone: 1-855-452-5234. Fax: 1-855-525-7207. For newly prescribed patients whose physician has determined that a trial dose of Jakafi is necessary to establish a safe starting dose for either (1) polycythemia vera who have had an inadequate response to or are intolerant of hydroxyurea or (2
Patient Enrollment Form IncyteCARES for PEMAZYRE® …
WEBUse this form to: • Enroll your patient in the IncyteCARES for PEMAZYRE Patient Assistance Program or Temporary Access Program • Write a prescription for PEMAZYRE®(pemigatinib) Please legibly complete all required fields. Fax completed form to 1-888-714-0016. We will contact you within 2 business days for program applications.
ZYNYZ Enrollment Form IncyteCARES for ZYNYZ
WEBcompany to disclose personal health information about me, including information related to my medical condition and treatment, my health insurance coverage, and my address, email address, and telephone number (collectively, my “PHI”) to Incyte, its agents, and the IncyteCARES for ZYNYZ program (collectively, “Incyte”) so that Incyte
IncyteCARES for ZYNYZ Program Enrollment Form
WEBIncyteCARES for ZYNYZ Program Enrollment Form. (Page 1 of 4) Please legibly complete all fields not marked optional, for timely processing. Fax completed form to 1-855-525-7207. We will contact you within 2 business days. For questions, call 1-855-452-5234. For details about all program services your patient can receive upon enrollment, see HCP
I ncyteCARES for Jakafi
WEBSpecialty Pharmacy Provider Network. The following specialty pharmacies are authorized to dispense Jakafi® (ruxolitinib) and are able to service most commercial, Medicaid, and Medicare Part D plans. If the pharmacy is not able to service the prescription, the prescription will be transferred to a pharmacy that can dispense the medication.
IncyteCARES for Jakafi Program Enrollment Form
WEBIncyteCARES for Jakafi Program Enrollment Form. Please legibly complete all fields not marked optional, for timely processing. Fax completed form to 1-855-525-7207. We will contact you within 2 business days. For questions, call 1-855-452-5234.
IncyteCARES for PEMAZYRE Enrollment Form
WEBIncyteCARES for PEMAZYRE Form (Page 2 of 4) CLINICAL INFORMATION Indication for which you are prescribing PEMAZYRE® (pemigatinib) tablets for this patient: Previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with a fibroblast growth factor receptor 2 (FGFR2) fusion or other rearrangement as detected by an FDA …
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