Besremi Prescribing & Dosing Schedule

Dosage & Administration Drug label Prior authorization Pharmacy Financial assistance Patient education People also ask

Besremi (ropeginterferon alfa-2b)

BESREMi 500 MCG in 1 ML Prefilled Syringe

Dosage & Administration

* Recommended starting dose: 100 mcg by subcutaneous injection every 2 weeks (50 mcg if receiving hydroxyurea).
* Increase the dose by 50 mcg every 2 weeks (up to a maximum of 500 mcg) until hematological parameters are stabilized ( 2.1)
* Interrupt or discontinue dosing if certain adverse reactions occur ( 2.3, 5)

drug label

Besremi Prescribing Information

Contact Medical Science Liaison

Report Adverse Event

prior authorization

Besremi Prior Authorization Resources

Most recent state uniform prior authorization forms

Verified: Jun 26, 2024Arizona - Uniform Prior Authorization Form

Verified: Jun 26, 2024Colorado - Uniform Prior Authorization Form

Verified: Jun 26, 2024Hawaii - Uniform Prior Authorization Form

Verified: Jul 26, 2024Illinois - Uniform Prior Authorization Form

Verified: Jun 26, 2024Indiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Louisiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Minnesota - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Mexico - Uniform Prior Authorization Form

Verified: Jun 26, 2024Oregon - Uniform Prior Authorization Form

Verified: Jun 26, 2024Texas - Uniform Prior Authorization Form

Verified: Jul 07, 2024Washington - Uniform Prior Authorization Form

Verified: Jul 07, 2024Wisconsin - Uniform Prior Authorization Form

Complete Letter of Medical Necessity

Coverage Authorization Appeals

Formulary Exception Letter

Benefits investigation

PharmaEssentia SOURCE Enrollment Form

Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

pharmacy

Besremi Preferred Pharmacy

Pharmacy List

financial assistance

Besremi Financial Assistance Options

Copay savings program

PharmaEssentia SOURCE Enrollment Form

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Bridge program

PharmaEssentia SOURCE Enrollment Form

Bridge Program

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

PharmaEssentia SOURCE Enrollment Form

Patient Assistance Program

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and copays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.