Your request will be referred to the appropriate Cephalon, LLC medical professional, such as a Synribo pharmaceutical rep; Medical Science Liaison (MSL) or medical affairs.
Need to report a Synribo issue?
ONLINE FORMReport adverse event
You can report a Synribo adverse event on MedWatch, the FDA's medical product safety reporting program for health professionals, patients and consumers.
Request Synribo samples
NOT PROVIDED BY BRANDView Online Sample Form
Is my patient elegible for Synribo samples?
Your rep will communicate with you how to receive samples, when you can receive samples, the amount and more.
How do I find out who my Synribo rep is?
Not sure who your local Synribo pharma rep is? Reach out to Cephalon, LLC and they can help you identify your rep.
Synribo Prior authorization resources
NOT PROVIDED BY BRANDComplete Letter of Medical Necessity
NOT PROVIDED BY BRANDCoverage Authorization Request
NOT PROVIDED BY BRANDCoverage Authorization Appeals
If available, these templates are provided by the brand to help you navigate insurance, especially with newer drugs.
SynCare Prescription & Service Request Form
Benefits investigations are conducted to determine whether a therapy is covered under a patient's insurance, if a prior authorization is required, and which specialty pharmacies are preferred.
Reimbursement help (FRM)
NOT PROVIDED BY BRANDReimbursement help (FRM) resources
Some brands offer a field reimbursement manager who will work with your clinical staff and preferred pharmacy to help make sure patients don't fall through the cracks.
Synribo Financial assistance options
Co-pay savings program
NOT PROVIDED BY BRANDEnroll in Patient Savings Program
Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)
A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max
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
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)
100% free (outside of insurance)
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)
TevaCares Patient Assistance Program Application
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
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
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
Synribo Patient education
Getting started on Synribo
Instructions For Use: Chronic or Accelerated Phase Chronic Myeloid Leukemia (CML)
ASK PATIENT TO: Open Camera on Phone Scan QR Code & Tap Link
NOT PROVIDED BY BRANDNot Provided By Brand
Other resources brands publish to help support patients and caregivers.
Can't find what you're looking for?
Our trained staff can help you:
Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
Samples are provided at the discretion of the brand.
We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.