Gocovri

(amantadine)

GOCOVRI 68.5 MG 24HR Extended Release Oral CapsuleGOCOVRI 137 MG 24HR Extended Release Oral Capsule

NO BLACK BOX WARNING

Dosage & administration

* Administer orally once daily at bedtime
* The initial daily dosage is 137 mg; after 1 week, increase to the recommended daily dosage of 274 mg
* Swallow whole; may sprinkle contents on soft food
* May be taken with or without food; avoid use with alcohol
* A lower dosage is recommended for patients with moderate or severe renal impairment

drug label

Gocovri prescribing information

Report Adverse Event

prior authorization

Gocovri prior authorization resources

PDFComplete Letter of Medical Necessity

PDFCoverage Authorization Appeals

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Benefits investigation

PDFGocovri Onboard and Prescription Form

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financial assistance

Gocovri financial assistance options

Co-pay savings program

commercial only

PDFGocovri Onboard and Prescription Form

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+

PDFGocovri Onboard and Prescription Form

OTHERPatient 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 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

Gocovri patient education

Getting started on Gocovri

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link