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Repathaready ® offers helpful resources to support you on your path to lower ldl bad cholesterol and to reduce your risk of heart attack or stroke. plan member information complete all sections of this page. among the 16, 676 patients without diabetes mellitus at baseline, the incidence of new‐ onset diabetes mellitus during the trial was 8. you can enroll in the repathaready ® program by visiting repatha. the most common adverse reaction that led to repatha treatment discontinuation and occurred at a rate greater than placebo was myalgia ( 0. may we contact you by email? • po box 19148, lenexa, ks 66285 • phone: • fax: • amgensafetynetfoundation. repatha will be approved based on repatha patient assistance program pdf all of the following criteria: ( 1) patient continues to receive statin at maximally tolerated dose ( unless patient has documented inability to take statins) - and- ( 2) patient is continuing a low- fat diet and exercise regimen - and- ( 3) prescribed by. , to offer free or low cost drugs to individuals who are unable to pay for their medication. if at any time patient begins receiving coverage under any such federal-, state-, or government- funded healthcare program, patient will no longer be able to use this offer and patient must callrepatha to stop participation.
immunogenicity: repatha ® is a human monoclonal antibody. to operate, administer, enroll me in, and/ or continue my participation in amgen’ s repathaready ® program or any other amgen- affiliated patient support services and activities related to my condition or treatment ( for example, co- pay card programs, reimbursement assistance programs, drug. repatha prices, coupons and patient assistance programs. click on one of the boxes below to take a closer look at the available services. mail to: johnson & johnson patient assistance foundation, inc. repatha is a medicine for lowering levels of fats in the blood. these programs may also be called indigent drug programs, charitable drug programs or medication assistance programs. amgen safety net foundation “ the foundation” is a nonprofit patient assistance program that helps qualifying patients access amgen medicines at no cost. or fax all completed, signed forms toor mail to po box 592188, orlando, flif you have insurance, fill out the insurance information section. 1% in patients assigned to repatha ® compared with 7. use a new repatha sureclick autoinjector, and callrepatha.
repatha ( evolocumab) is a member of the pcsk9 inhibitors drug class and is commonly used for cardiovascular risk reduction, high cholesterol, high cholesterol - familial heterozygous and others. amgen is committed to providing personalized support services for patients and providers in the u. 0, comments, side effects, dosage, sex, age, time taken. patient assistance program patient id number: contact name: phone number: ( continued on next page) page 2 of 7. - cvs caremark is an independent company that provides pharmacy benefit management services to carefirst bluecross blueshield and carefirst bluechoice, inc. patient assistance program po box 0367, chesterfield, mo 63006 fax: if you have questions about johnson & johnson patient assistance foundation, inc. patient assistance program. a healthcare provider who knows how to use the repatha sureclick autoinjector should be. com or by contactingrepatha. repathaready is a comprehensive suite of services to help patients and providers, including a repatha co- pay card for eligible commercial patients, insurance coverage support and injection training. if a dose is missed, instruct the patient to administer repatha within 7 days from the missed dose and resume the patient’ s original schedule.
( note that some correspondence may still need to be sent by regular mail). cholesterol levels. patient with medicare part d will be considered on a case by case basis. this is a copay assistance program: provided by: patient access network foundation: tel: fax: : languages spoken: english, spanish, others by translation service. carefirst bluecross. recommended dosage. praluent can help adults with cardiovascular ( cv) disease reduce the risk of heart attack, stroke, or certain types of chest pain conditions ( unstable angina) requiring hospitalization. through its repathaready™ program. patient assistance program p.
manufacturer the minimum necessary information about my health pdf condition and prescriptions to: coordinate the delivery of products and services available through the patient assistance program, aggregate de- identified data for market analysis, and provide educational regarding therapies. , co- pay card programs, reimbursement assistance programs, drug coverage verification, nurse educator services, adherence program, and disease management support) ;. , high- intensity statin) is required. adverse reactions occurring in greater than or equal to 3% of repatha- treated. • po box 18769, louisville, ky• phone: • fax: • amgensafetynetfoundation. patient education: high cholesterol and lipid treatment options ( beyond the basics). adverse reactions in the cardiovascular outcomes trial: the most common adverse reactions ( > 5% of patients treated with repatha ® and occurring more frequently than placebo) were: diabetes mellitus ( 8.
of the following: ( a) cardiologist ( b) endocrinologist. patient support services and activities related to my condition or treatment ( e. johnson & johnson patient assistance foundation, inc. when monitoring ldl- c for patients receiving repatha 420 mg once monthly, note that ldl - c can vary considerably during the dosing interval in some patients [ see clinical studies ( 14) ]. repatha ® can also be stored at room temperature ( 68° f to 77° f). a single room temperature exposure event is allowable within the shelf life, and the room temperature exposure duration must not exceed 30 days. the pcsk9 inhibitors include alirocumab ( brand name: praluent) and evolocumab ( brand name: repatha ), which are given by injection every two to four weeks. program website : program applications and forms: patient access network foundation ( pan) application: contact program. placebo), nasopharyngitis ( 7. if repatha is to be used to reduce the risk of mi, stroke, and coronary revascularization in adults with established cardiovascular disease, documentation that member will use in combination with an optimized regimen of lipid- lowering therapy ( e.
and group hospitalization and medical services, inc. ( jjpaf) or how to complete this form, please contact us at, 9am – 6pm est, monday through friday. 8% repatha ®, 8. com • page 3 of 4. includes 54 patient ratings with average score of 2. the patient' s insurance must cover the qualifying medication that they are seeking assistance for.
2% placebo), nasopharyngitis ( 7. 1% repatha ®, 4. n n n n n n n n n n n n. patients must be at or below% repatha patient assistance program pdf of the federal poverty level, must have a medically appropriate diagnosis/ condition and must reside and receive treatment in the us. among the 16, 676 patients without diabetes mellitus at baseline, the incidence of new- onset diabetes mellitus during the trial was 8. 7% in those assigned to placebo.
patient assistance program enrollment form ü i am a medicare patient with prescription coverage and i meet the income restrictions described below do i qualify for pass? amgen safety net foundation ( asnf) is a nonprofit patient assistance program that helps patients with financial need gain access to amgen medicines at no cost. 4% placebo), and upper respiratory tract infection ( 5. it is used to reduce blood fat levels in patients with primary hypercholesterolaemia ( high blood cholesterol levels caused by repatha patient assistance program pdf a genetic abnormality), homozygous familial hypercholesterolaemia ( a severe form of high blood cholesterol inherited from both parents) and mixed dyslipidaemia ( abnormal levels of different fats, including. for adults with medicare or medicaid, if you’ re enrolled in medicare extra repatha patient assistance program pdf help or low income subsidy ( lis), you’ ll pay no more than $ 10 per month for repatha ®. 1% in patients assigned to repatha® compared with 7. 2% of repatha- treated patients and 1% of placebo- treated patients. patient assistance program enrollment form ü i am a medicare patient with prescription coverage and i meet the income restrictions described below do i qualify for pass? store repatha ® in the refrigerator ( 36° f to 46° f) until you’ re ready to use it.
patient assistance program that helps qualifying patients access amgen medicines at no cost. patient assistance program patient id number: contact name: phone number: ( continued on next page) m6453( repatha) - 8/ 19. if you’ ve had a potentially life- threatening heart event such as a heart attack or a stroke, your chances of suffering another one are 1 in 3. carefirst bluecross blueshield is the shared business name of carefirst of maryland, inc. box 221857, charlotte, ncif you have any questions, callname: telephone: email: social security # : date of birth: gender: male female address ( street, city, state, zip) : 1 patient information total gross yearly income. patient assistance program patient id number: contact name: phone number: m6453( repapral) - 8/ 20 ( continued on next page) page 2 of 7. the recommended subcutaneous dosage of repatha in adults with established cardiovascular disease or in adults with primary hyperlipidemia ( including hefh) is either 140 mg every 2 weeks or 420 mg once monthly, based on patient preference for dosing frequency and injection volume.
8% repatha ®, 7. patient assistance programs ( paps) are programs created by drug companies, such as amgen, inc. repatha™ patient start program, reimbursement assistance programs, drug coverage verification, nurse educator services, and disease management support; • to contact, upon my permission, my healthcare team ( including my doctor and his team) and share with them some of my. • do not use the repatha sureclick autoinjector after the expiration date. consumer ratings and reviews for repatha. if you have questions about repatha ® or the repathaready ® program and would like to speak to a counselor, please callrepatha. sign up for repathaready ® or callrepatha, 9 am– 11 pm et.
in order to qualify for the program, the patient must spend 4% or more of their gross annual income on prescription drugs; the patient’ s income level is equal to or less than 300% above the u. this applies to copayments, coinsurance, and prescription deductibles ( subject to plan design). 08/ 20- 21 • po box 18769, louisville, ky• phone: • fax: • amgensafetynetfoundation. important safety information do not use repatha ® if you are allergic to evolocumab or to any of the ingredients in repatha ®. praluent ( alirocumab), repatha ( evolocumab) ( if coverage is not provided by great- west life please provide pharmacy print- out showing purchase of this drug) m6453( repapral) - 10/ 19. federal poverty guidelines; the patient lives in the united states or a u. repatha ® support. 3% versus 0% for repatha and placebo, respectively). patient information. part of the repatha sureclick autoinjector may be broken even if you cannot see the break.