Exondys

(eteplirsen)

Exondys 51, 100 MG in 2 ML InjectionExondys 51, 500 MG in 10 ML Injection

NO BLACK BOX WARNING

Dosage & administration

* 30 milligrams per kilogram of body weight once weekly
* Administer as an intravenous infusion over 35 to 60 minutes via an in-line 0.2 micron filter
* Dilution required prior to administration

drug label

Exondys prescribing information

Report Adverse Event

prior authorization

Exondys prior authorization resources

Most recent Exondys prior authorization forms

View By Payer

Verified: Oct 02, 2023Blue Cross Blue Shield of Michigan - FEP Exondys 51 Prior Authorization Form (Medical Benefit)

Verified: Sep 27, 2023Cigna - Duchenne Muscular Dystrophy (DMD) Prior Authorization Forms

Verified: Sep 26, 2023Blue Cross Blue Shield of Michigan - Exondys 51 Prior Authorization Form (Medical Benefit)

Verified: Sep 21, 2023Aetna - Exondys 51 Prior Authorization Form

Verified: Sep 20, 2023Aetna - Medicare Part B Exondys 51 Prior Authorization Form

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Benefits investigation

PDFSareptAssist Start Form

PDFSareptAssist Start Form - Spanish

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financial assistance

Exondys financial assistance options

Co-pay savings program

commercial only

OTHEREnroll 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

Foundation programs

under insured

no insurance

goverment insurance

65+

OTHERPatient Assistance Program (PAP)

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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 co-pays) 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

Exondys patient education

Getting started on Exondys

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link