•Eligible patients who were denied coverage by their insurance company may be able to receive Fasenra for up to 24 months
•In order to receive the benefits of the FASENRA Denied Patient Savings Program – A Prior Authorization (PA) Denial and PA Appeal Denial by patient's health plan are required to be eligible for this program
•FASENRA must be prescribed to a new patient for a Food and Drug Administration (FDA)approved use to be eligible for this program
•This program is only offered through approved specialty pharmacies
•Program support includes periodic Benefits Investigation to identify potential changes in patient coverage. If a change in coverage is identified, the prescriber will be contacted to initiate a new Prior Authorization for the patient. If the Prior Authorization is approved, the patient will transition to coverage via their insurance benefits
•Offer is invalid for claims or transactions more than 180 days from the date of service
•HCP will be notified that the patient meets program requirements within 2 days of receipt of a complete application
•HCP must complete and fax the following information to the Denied Patient Savings Program at 8333292360:
•1. Denied Patient Savings form
•2. AstraZeneca Access 360 Enrollment Form
•3. Copies of the PA denial and PA appeal denial
•4. Signed patient authorization (see Section 2 of FASENRA Access 360 Enrollment Form). This is not required to complete enrollment into the program but will be required for subsequent refills