Dosage & Administration Drug label Prior authorization Financial assistance

Uplizna

(inebilizumab)

10 ML inebilizumab-cdon 10 MG/ML Injection [Uplizna]

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

Uplizna prescribing information

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prior authorization

Uplizna Prior authorization resources

Complete Letter of Medical Necessity

Coverage Authorization Request

Coverage Authorization Appeals

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Benefits investigation

Uplinza Patient Enrollment Form

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Reimbursement help (FRM)

NOT PROVIDED BY BRANDReimbursement help (FRM) resources

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financial assistance

Uplizna 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

Uplinza Patient Enrollment Form

Starter 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)

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

Uplizna Patient education

Getting started on Uplizna

NOT PROVIDED BY BRANDInstructions For Use - Neuromyelitis Optica Spectrum Disorder (NMOSD)

Patient toolkit

About Uplinza

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

Patient Resources

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

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Uplizna FAQs

FAQ Data Source

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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.

Uplizna

Dosage & administration

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Uplizna prescribing information

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prior authorization

Uplizna Prior authorization resources

Benefits investigation

Reimbursement help (FRM)

financial assistance

Uplizna 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

Uplizna Patient education

Getting started on Uplizna

Patient toolkit

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Uplizna FAQs

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