Dosage & Administration Drug label Prior authorization Financial assistance

Qutenza

(capsaicin)

capsaicin 0.08 MG/MG Medicated Patch [Qutenza]

NO BLACK BOX WARNING

Dosage & administration

* Only physicians or health care professionals are to administer QUTENZA. ( 2.1)
* Administer QUTENZA in a well-ventilated treatment area. ( 2.1)
* Wear nitrile (not latex) gloves when handling QUTENZA and when cleaning treatment areas. ( 2.1)
* Use of a face mask and protective glasses is advisable for healthcare professionals. ( 2.1)
* Do not use QUTENZA on broken skin. ( 2.1)
* PHN: Apply up to four topical systems for 60 minutes. ( 2.2)
* DPN: Apply up to four topical systems for 30 minutes on the feet. ( 2.2)
* Repeat every 3 months or as warranted by the return of pain (not more frequently than every three months). ( 2.2)
* See Dosage and Administration, Instructions for Use, for detailed instructions on QUTENZA administration. ( 2.3)

Qutenza prescribing information

Need to report a Qutenza issue?

ONLINE FORMReport adverse event

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prior authorization

Qutenza Prior authorization resources

Complete Letter of Medical Necessity

Coverage Authorization Request

Coverage Authorization Appeals

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Benefits investigation

Qutenza Benefit Request and Prescription Form

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Qutenza Financial assistance options

Co-pay savings program

commercial only

Enroll 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

Bridge program

commercial only

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Overview

Provide patient immediate access to therapy during an insurance delay (typically new starts; some may cover change in insurance)
Limited time/ fill (typically 7-30 days; some may offer additional fill for continued delay up to certain limit)

Patient benefit

100% free (outside of insurance)

Patient eligibility

HCP must enroll patient
May be limited to commercially insured patients (i.e., no government beneficiaries); some programs may allow government beneficiaries

How to sign up

Typically HCP assisted enrollment (via form)

Foundation programs

under insured

no insurance

goverment insurance

65+

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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