Dosage & Administration Drug label Prior authorization Financial assistance Patient education People also ask

Sprycel(dasatinib)

SPRYCEL 20 MG Oral Tablet

NO BOXED WARNING

Dosage & Administration

* Chronic phase CML in adults: 100 mg once daily. (2)
* Accelerated phase CML, myeloid or lymphoid blast phase CML, or Ph+ ALL in adults: 140 mg once daily. (2)
* Chronic phase CML and ALL in pediatrics: starting dose based on body weight. (2)
* Administer orally, with or without a meal. Do not crush, cut, or chew tablets. (2)

drug label

Sprycel Prescribing Information

Contact Medical Science Liaison

Report Adverse Event

prior authorization

Sprycel Prior Authorization Resources

Most recent state uniform prior authorization forms

Verified: Jun 26, 2024Arizona - Uniform Prior Authorization Form

Verified: Jun 26, 2024Colorado - Uniform Prior Authorization Form

Verified: Jun 26, 2024Hawaii - Uniform Prior Authorization Form

Verified: Jul 26, 2024Illinois - Uniform Prior Authorization Form

Verified: Jun 26, 2024Indiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Louisiana - Uniform Prior Authorization Form

Verified: Jun 26, 2024Minnesota - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Hampshire - Uniform Prior Authorization Form

Verified: Jun 26, 2024New Mexico - Uniform Prior Authorization Form

Verified: Jun 26, 2024Oregon - Uniform Prior Authorization Form

Verified: Jun 26, 2024Texas - Uniform Prior Authorization Form

Verified: Jul 07, 2024Washington - Uniform Prior Authorization Form

Verified: Jul 07, 2024Wisconsin - Uniform Prior Authorization Form

Complete Letter of Medical Necessity

Coverage Authorization Appeals

Commercial Claim Denial Appeal/Redetermination Letter

Medically Unlikely Edit (MUE) Appeal Letter

Benefits investigation

Sprycel Enrollment Form

Sprycel Enrollment Form - Spanish

Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

Financial Assistance

Financial Assistance Programs

Sprycel retails for $178 per dose without insurance or financial assistance.Depending on your patient's insurance situation and other eligibility criteria, they may be able to get Sprycel for significantly less. Review the program information below to determine what program can offer your patient the most benefits.

Copay Card Program$0 Copay

Available for

commercial

Program Details

Program Expires Calendar Year

Forms

Sprycel Enrollment Form

Sprycel Enrollment Form - Spanish

Enroll in Patient Savings Program

patient education

Sprycel Patient Education

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link