IncyteCARES for Pemazyre Patient Assistance Program

Funded

About

The IncyteCARES for Pemazyre Patient Assistance Program provides significant benefits for patients receiving Pemazyre. It supports U.S. residents with a valid prescription for Pemazyre, ensuring that eligible and enrolled patients can access their medication at potentially no cost. Whether uninsured, underinsured, or experiencing coverage denials, the program guides patients through a simple enrollment process to help ease financial burdens associated with Pemazyre.

Insurance requirements: Commercially insured, 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 do not have prescription drug insurance or who have trouble affording their outofpocket costs for PEMAZYRE may be able to receive their medication at no cost

•HCP can enroll patient online, or download application from https://hcp.incytecares.com/pdf/pemazyre.pdf and fax the completed form to 18887140016

•Within 2 business days of receiving the IncyteCARES for PEMAZYRE form, patients are notified of "conditional approval" for the program; this allows them to receive free medication for 90 days

•Full approval is only granted once the patient’s proof of income is submitted and confirmed

•For assistance or additional information, call 8554525234, Monday through Friday, 8 am–8 pm ET

Enrollment Forms

Enrollment Form