•Eligible patients may pay as little as $0 per infusion
•Program assistance cap of $200 per infusion for eligible administration costs; calendar year maximum on all program assistance for all outofpocket expenses
•Copay assistance applies to the cost of the product only; any administration costs (e.g., cost of IV infusion) or other fees are the responsibility of the patient.
•Must have a valid prescription for VYEPTI (up to 300 mg) for an approved indication at the time the prescription is filled by the pharmacist, or at the time the HCP administers VYEPTI to the patient
•HCP or office personnel will need to fax or email documentation, typically in the form of an Explanation of Benefits (EOB) after each dose.
•• The tollfree fax number is 8662183479; reimbursement will be sent after the EOB is reviewed and approved
•All documentation can also be mailed to: Attn: VYEPTI CONNECT Copay Assistance Program, 2250 Perimeter Park, Suite 300, Morrisville, NC 27560
•Patient enrollment will automatically renew each calendar year
•Call 8334893784, Monday through Friday, 8 AM 8 PM ET, for assistance or additional information
•Patients residing in MA, MN, and RI are not eligible for copay assistance for product administration costs