Lemtrada Co-Pay Program

Funded

About

The Lemtrada Co-Pay Program is designed to help eligible patients minimize their out-of-pocket costs for Lemtrada medication. With the Lemtrada Co-Pay Program, patients pay $0 for the drug and may receive up to $100 per day of infusion towards infusion administration costs, making treatment more accessible and affordable.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Patients pay $0 outofpocket for medication; program also covers up to $100 for each day of infusion toward the cost of infusion administration

•HCP must fax completed LEMTRADA Service Form to 8555572478 to enroll patient in support services and LEMTRADA REMS

•Direct link to download form is not available; it must be downloaded from the LEMTRADA Resources page (check the box for LEMTRADA Services Form)

•A One to One Nurse will contact the patient to explain program benefits

•If eligible, patient will receive card by mail, with instructions on how to submit for benefits

•Whenever a bill or Explanation of Benefits has been submitted, patient must reference the member ID number on card

•Treatmentrelated, infusion outofpocket costs are not reimbursable in MA, MI, or RI

•If healthcare facility is submitting for patient, copy of LEMTRADA CoPay Card must also be submitted

Enrollment Forms

Enrollment Form