Amgen Safety Net Foundation: Otezla

Funded

About

The Amgen Safety Net Foundation: Otezla program offers a crucial support network for patients in need of Otezla, ensuring access to essential medication. The program provides free Otezla medications to eligible patients who are uninsured or underinsured, focusing on those who cannot afford their out-of-pocket costs. With a commitment to facilitating healthcare access, the Amgen Safety Net Foundation: Otezla program remains a vital resource, aiding patients through comprehensive enrollment and renewal processes.

Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible patients who have a financial need, and are uninsured or underinsured for the Amgen medicine may be able to receive free medications

•Foundation supports underinsured patients (including Medicare Part D) who have limited coverage for Amgen medications in certain situations

•Medicare Part D patients with product coverage who cannot afford their outofpocket costs must:

•1. Demonstrate their inability to afford the medicine

•2. Not be eligible for Medicaid or Medicare’s lowincome subsidy (Extra Help)

•3. Satisfy all payer guidelines and Prior Authorization (PA) requirements prior to applying for assistance

•4. Not have any other financial support option

•Patient needs to fill out and sign the Patient Application

•HCP needs to fill out the Product Prescription Form (located here: https://www.amgensafetynetfoundation.com/assets/pdf/AMGENSNFProductPrescriptionFormOtezla.pdf)

•Patient's HCP should fax completed application and prescription forms to 8339591409

•Once a completed application and any requested supporting documents have been received and processed, the patient and provider will be notified of the enrollment decision

•Missing information or an incomplete application will delay an enrollment decision

•Eligible patients are enrolled for a period up to 12 months. To reenroll in Amgen Safety Net Foundation, patients must submit a new application

•Once a patient has been enrolled, they will be contacted by Amgen Safety Net Foundation to provide consent for shipment. Prescription products are shipped directly to the patient

•For questions or more information, contact Amgen Safety Net Foundation at 8009323060, Monday through Friday 8am to 8pm Eastern Time

Enrollment Forms

Enrollment Form