Dosage & Administration Drug label Prior authorization Financial assistance

Ultomiris

(ravulizumab)

11 ML ravulizumab-cwvz 100 MG/ML Injection [Ultomiris]3 ML ravulizumab-cwvz 100 MG/ML Injection [Ultomiris]

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Dosage & administration

* See Full Prescribing Information for instructions on dosage, preparation, and administration .
* Dilute ULTOMIRIS before use .
* Only administer as an intravenous infusion through a 0.2 or 0.22 micron filter .

Ultomiris prescribing information

Have more Ultomiris questions?

Submit MSL Request

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Need to report an Ultomiris issue?

ONLINE FORMReport adverse event

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prior authorization

Ultomiris Prior authorization resources

NOT PROVIDED BY BRANDComplete Letter of Medical Necessity

NOT PROVIDED BY BRANDCoverage Authorization Request

NOT PROVIDED BY BRANDComplete Coverage Authorization appeals

Coverage Authorization Appeals - Paroxysmal Nocturnal Hemoglobinuria (PNH)

Letter of Medical Necessity - Paroxysmal Nocturnal Hemoglobinuria (PNH)

Ultomiris Access & Reimbursement Guide - All Indications

Letter of Medical Necessity - Atypical Hemolytic Uremic Syndrome (Atypical-HUS)

Letter of Medical Necessity - anti-AChR Atibody Positive Generalized Myasthenia Gravis (gMG)

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Benefits investigation

Ultomiris Start Form - PNH/Atypical-HUS

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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financial assistance

Ultomiris 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

patient education

Ultomiris Patient education

Getting started on Ultomiris

NOT PROVIDED BY BRANDInstructions For Use - Paroxysmal Nocturnal Hemoglobinuria (PNH)

NOT PROVIDED BY BRANDInstructions For Use - Atypical Hemolytic Uremic Syndrome (Atypical-HUS)

NOT PROVIDED BY BRANDInstructions For Use - anti-AChR Atibody Positive Generalized Myasthenia Gravis (gMG)

Patient toolkit

About Ultomiris - Paroxysmal Nocturnal Hemoglobinuria (PNH)

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Patient Resources - Paroxysmal Nocturnal Hemoglobinuria (PNH)

ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Learn More

Ultomiris FAQs

FAQ Data Source

Can't find what you're looking for?

Our trained staff can help you:

Please note:

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.

Ultomiris

Dosage & administration

Most viewed Ultomiris resources

drug label

Ultomiris prescribing information

Have more Ultomiris questions?

Need to report an Ultomiris issue?

prior authorization

Ultomiris Prior authorization resources

Benefits investigation

Reimbursement help (FRM)

financial assistance

Ultomiris Financial assistance options

Co-pay savings program

Overview

Patient benefit

Patient eligibility

How to sign up

Bridge program

Overview

Patient benefit

Patient eligibility

How to sign up

Foundation programs

Overview

Patient benefit

Patient eligibility

How to sign up

patient education

Ultomiris Patient education

Getting started on Ultomiris

Patient toolkit

people also ask

Ultomiris FAQs

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