Uplizna

(inebilizumab)

UPLIZNA 3 Vial KitUPLIZNA 100 MG in10 ML Injection

NO BLACK BOX WARNING

Dosage & administration

* Hepatitis B virus, quantitative serum immunoglobulins, and tuberculosis screening is required before the first dose

* Prior to every infusion:
* Determine if there is an active infection

* Premedicate with a corticosteroid, an antihistamine, and an antipyretic

* UPLIZNA must be diluted in 250 mL of 0.9% Sodium Chloride Injection, USP prior to administration

* UPLIZNA is administered as an intravenous infusion titrated to completion, approximately 90 minutes. The recommended dose is:
* Initial dose: 300 mg intravenous infusion followed two weeks later by a second 300 mg intravenous infusion

* Subsequent doses (starting 6 months from the first infusion): single 300 mg intravenous infusion every 6 months

* Monitor patients closely during the infusion and for at least one hour after completion of the infusion

drug label

Uplizna prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Uplizna prior authorization resources

Most recent Uplizna prior authorization forms

View By Payer

Updated: May 31, 2023Cigna - Uplinza Prior Authorization Form

Updated: May 29, 2023Blue Cross Blue Shield of Michigan - Uplinza Prior Authorization Form (Medical Benefit)

Updated: May 24, 2023Aetna - Medicare Part B Uplinza Prior Authorization Form

Updated: May 24, 2023Aetna - Uplinza Prior Authorization Form

OTHERComplete Letter of Medical Necessity

OTHERCoverage Authorization Appeals

PDFPA Considerations

PDFPA Checklist

PDFAppeals Checklist

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Benefits investigation

PDFUplinza Patient Enrollment Form

Uplinza Patient Enrollment Form - Online

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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pharmacy

Uplizna preferred pharmacy

PDFPharmacy List

financial assistance

Uplizna financial assistance options

Co-pay savings program

commercial only

PDFUplinza Patient Enrollment Form

Uplinza Patient Enrollment Form - Online

OTHEREnroll 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

PDFUplinza Patient Enrollment Form

Uplinza Patient Enrollment Form - Online

PDFStarter Bridge Program

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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)

patient education

Uplizna patient education

Getting started on Uplizna

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link