Saphnelo Denied Patient Savings Program

Funded

About

The Saphnelo Denied Patient Savings Program offers substantial benefits to eligible patients who have been denied insurance coverage for the drug Saphnelo. Through this program, patients can receive Saphnelo for up to 24 months, minimizing costs and supporting access to this important medication. The program requires a prior authorization denial and appeal denial, ensuring support is directed to those most in need. Operated through specialty pharmacies, the Saphnelo Denied Patient Savings Program also provides ongoing benefits investigation to optimize patient insurance coverage.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible patients who were denied coverage by their insurance company may be able to receive Saphnelo for up to 24 months

•In order to receive the benefits of the SAPHNELO Denied Patient Savings Program – A Prior Authorization (PA) Denial and PA Appeal Denial by patient's health plan are required to be eligible for this program

•SAPHNELO must be prescribed to a new patient for a Food and Drug Administration (FDA)approved use to be eligible for this program

•This program is only offered through approved specialty pharmacies

•Program support includes periodic Benefits Investigation to identify potential changes in patient coverage. If a change in coverage is identified, the prescriber will be contacted to initiate a new Prior Authorization for the patient. If the Prior Authorization is approved, the patient will transition to coverage via their insurance benefits

•Offer is invalid for claims or transactions more than 365 days from the date of service

•HCP must complete and fax the following information to the Denied Patient Savings Program at 8665112360:

•1. Denied Patient Savings form (https://www.myaccess360.com/content/dam/websiteservices/us/552access360/hcppdf/SAPHNELO_Denied_Patient_Savings_Program_Form.pdf)

•2. AstraZeneca Access 360 Enrollment Form

•3. Copies of the PA denial and PA appeal denial

•4. Signed patient authorization (see Section 2 of SAPHNELO Access 360 Enrollment Form). This is not required to complete enrollment into the program but will be required for subsequent refills

•HCP will be notified that the patient meets program requirements within 2 days of receipt of a complete application

•If patients have any questions call Access 360 at 1866SAPHNELO (18667274635) MondayFriday, 8 AM6 PM EST

Enrollment Forms

Enrollment Form