Empliciti(elotuzumab)
NO BOXED WARNING

Dosage & Administration

Get Your Patient on Empliciti

See your patient's specific prior authorization requirements including coverage restrictions and step therapies
Insurance Carrier
Or select your Insurance from the list below:

Empliciti Prescribing Information

Empliciti Prior Authorization Resources

Most recent state uniform prior authorization forms

Verified: Oct 24, 2024Arizona - Uniform Prior Authorization Form
Verified: Oct 24, 2024Colorado - Uniform Prior Authorization Form
Verified: Oct 24, 2024Hawaii - Uniform Prior Authorization Form
Verified: Oct 24, 2024Illinois - Uniform Prior Authorization Form
Verified: Oct 24, 2024Indiana - Uniform Prior Authorization Form
Verified: Oct 24, 2024Louisiana - Uniform Prior Authorization Form
Verified: Oct 24, 2024Minnesota - Uniform Prior Authorization Form
Verified: Oct 24, 2024New Hampshire - Uniform Prior Authorization Form
Verified: Oct 24, 2024New Mexico - Uniform Prior Authorization Form
Verified: Oct 24, 2024Oregon - Uniform Prior Authorization Form
Verified: Oct 24, 2024Texas - Uniform Prior Authorization Form
Verified: Nov 04, 2024Washington - Uniform Prior Authorization Form
Verified: Nov 04, 2024Wisconsin - Uniform Prior Authorization Form
Commercial Claim Denial Appeal/Redetermination Letter
Coverage Authorization Appeals
Complete Letter of Medical Necessity
Medically Unlikely Edit (MUE) Appeal Letter

Benefits investigation

Empliciti Enrollment Form
Empliciti Enrollment Form - Spanish

Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

Financial Assistance

Financial Assistance Programs

Empliciti retails for $2,313 per dose without insurance or financial assistance.Depending on your patient's insurance situation and other eligibility criteria, they may be able to get Empliciti for significantly less. Review the program information below to determine what program can offer your patient the most benefits.
Copay Card Program$0 Copay
Available for
commercial
Program Details
  • Program Expires Calendar Year
Forms
Empliciti Enrollment Form
Empliciti Enrollment Form - Spanish
Enroll in Patient Savings Program

Empliciti PubMed™ News

    Empliciti Patient Education

    To share resource; ask patient to:
    1.Pull out phone
    2.Open camera
    3.Scan QR code with camera
    4.Tap link

    Patient toolkit

    About Empliciti
    ASK PATIENT TO:
    Open Camera on Phone
    Scan QR Code & Tap Link

    Empliciti FAQs