Breyanzi Prescribing & Dosing Schedule

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

Breyanzi(lisocabtagene maraleucel)

Breyanzi 70,000,000 CELLS/mL in 4.6 mL Injection

Dosage & Administration

For autologous use only. For intravenous use only.

* Do NOT use a leukodepleting filter .
* Administer a lymphodepleting regimen of fludarabine and cyclophosphamide before infusion of BREYANZI .
* Verify the patient’s identity prior to infusion .
* Premedicate with acetaminophen and an H1 antihistamine .
* Confirm availability of tocilizumab prior to infusion .
* Dosing of BREYANZI is based on the number of chimeric antigen receptor (CAR)-positive viable T cells .
* For LBCL:
* after one line of therapy, the dose is 90 to 110 × 106 CAR-positive viable T cells .
* after two or more lines of therapy, the dose is 50 to 110 × 106 CAR-positive viable T cells .
* For CLL/SLL, FL and MCL:
* the dose is 90 to 110 × 106 CAR-positive viable T cells .
* Administer BREYANZI in a REMS-certified healthcare facility .

Breyanzi Prescribing Information

Contact Medical Science Liaison

Report Adverse Event

prior authorization

Breyanzi 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 Request

Coverage Authorization Appeals

Breyanzi PA Tip Sheet

Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

financial assistance

Breyanzi Financial Assistance Options

Copay savings program

Enroll in Patient Savings Program

Learn More

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

Foundation programs

Cell Therapy 360 Patient Assistance Program

Learn More

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.

How to sign up

Patients submit proof of out-of-pocket drug costs to charities for reimbursement

patient education

Breyanzi Patient Education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link