Dosage & Administration Biomarker testing Drug label Prior authorization Pharmacy Financial assistance

Zynlonta

(loncastuximab tesirine)

loncastuximab tesirine-lpyl 10 MG Injection [Zynlonta]

NO BLACK BOX WARNING

Dosage & administration

* ZYNLONTA is an intravenous infusion over 30 minutes on Day 1 of each cycle (every 3 weeks). The recommended dosage is:
* 0.15 mg/kg every 3 weeks for 2 cycles.
* 0.075 mg/kg every 3 weeks for subsequent cycles.

* Premedicate with dexamethasone 4 mg orally or intravenously twice daily for 3 days beginning the day before ZYNLONTA.
* See Full Prescribing Information for instructions on preparation and administration.

biomarker testing

Zynlonta clinical details

Genetic testing requirements were obtained from the NCCN guidelines for each cancer type.

drug label

Zynlonta prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Zynlonta prior authorization resources

Most recent Zynlonta prior authorization forms

View By Payer

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

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

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

OTHERComplete Letter of Medical Necessity

OTHERCoverage Authorization Appeals

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Benefits investigation

PDFZynlonta Patient Enrollment Form

Zynlonta Patient Enrollment Form - Online

Patient Authorization

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pharmacy

Zynlonta preferred pharmacy

PDFPharmacy List

financial assistance

Zynlonta financial assistance options

Co-pay savings program

commercial only

PDFZynlonta Patient Enrollment Form

Zynlonta Patient Enrollment Form - Online

Patient Authorization

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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

Foundation programs

under insured

no insurance

goverment insurance

65+

PDFZynlonta Patient Enrollment Form

Zynlonta Patient Enrollment Form - Online

OTHEREnroll in Patient Savings Program

OTHERPatient Assistance Program

Patient Assistance Program (PAP) Consent Form

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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

Zynlonta patient education

Getting started on Zynlonta

To share resource; ask patient to:

1.Pull out phone

2.Open camera

3.Scan QR code with camera

4.Tap link