CareASSIST Copay Program for SARCLISA® (isatuximab-irfc) Patients

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Eligible patients with commercial insurance may pay as little as $0. This includes any product-specific copay, coinsurance, and insurance deductibles – up to $25,000 in assistance per year. Restrictions apply.*

Out-of-pocket Responsibility

You are responsible for any SARCLISA® (isatuximab-irfc) out-of-pocket costs that exceed the program assistance limit of $25,000 per year. This is in addition to non–SARCLISA-specific expenses related to supplies, procedures, or physician-related services.

Eligibility Requirements

Insurance – You must have commercial or private insurance, which includes state or federal employee plans and health insurance exchanges
Residency – You must be a resident of the US or its territories or possessions
Income – There is no income requirement to qualify for this program

Other conditions apply.

How to Apply for the CareASSIST Copay Program

To get started, you or your healthcare provider can download and print a CareASSIST application. Make sure the Copay Assistance box in Section 1 is checked.

You and your healthcare provider must fill out and sign portions of your application. Once completed, your healthcare provider must submit the application by fax or mail.

Fax

1-855-411-9689

Mailing address

CareASSIST by Sanofi Genzyme

PO Box 220616

Charlotte, NC 28222

If you do not have access to a computer and printer, you may start the application process by calling CareASSIST at 1-833-WE+CARE (1-833-930-2273, Option 1), Mon – Fri, 9 AM – 8 PM ET. A CareASSIST Patient Access Specialist will assist you with the next steps.

After Applying for the CareASSIST Copay Program

Upon receiving the CareASSIST application, CareASSIST Patient Access Specialists will review it for copay program eligibility. If your eligibility is confirmed, you will receive a notification via US mail that contains your copay number. This information should be retained and included with any reimbursement claims that you submit.

Please note: CareASSIST will only review applications for copay program eligibility if the Copay Assistance box is checked.

You will be enrolled in the program for 12 months dating from the time of approval, and will be evaluated for continued eligibility on an annual basis. Enrollment will be renewed if eligibility is confirmed.

If you are ineligible for this program, now or after an annual review, CareASSIST will notify you by US mail.

How CareASSIST Handles Patient Reimbursement

In order to be reimbursed, you must submit the following paperwork to CareASSIST within 120 days of the date of treatment:

Your invoice for your SARCLISA prescription
Your insurance company’s explanation of benefits
Payment receipts
Billing statements
A completed proof of expense form

You may seek reimbursement for treatments that you have received in the 120 days prior to the date of enrollment in the CareASSIST Copay Program.

Note that some healthcare providers may choose to submit all documentation necessary for reimbursement on your behalf. Discuss these details with your healthcare provider or their office staff.

After CareASSIST receives all required documentation, the copay billing specialist team will perform a review to determine your out-of-pocket costs. Once these materials are reviewed and approved, you will receive a reimbursement check from CareASSIST in approximately 7 to 14 business days.

CareASSIST Copay Program Resources

CareASSIST Copay Programoverview brochure Copay programproof of expense form

*Subject to annual maximum copay assistance amount of $25,000. This program is not valid for prescriptions covered by or submitted for reimbursement under Medicare, Medicaid, Veterans Affairs/Department of Defense, TRICARE, or similar federal or state programs. Not a debit card program. The program does not cover or provide support for supplies, procedures, or any physician-related service associated with SARCLISA® (isatuximab-irfc). General non–product-specific copays, coinsurance, or insurance deductibles are not covered. This program only applies to patients who are at least 18 years of age, residents of the United States or its territories or possessions, are prescribed SARCLISA for an FDA-approved indication, and are insured by a commercial health plan that requires a copayment, coinsurance, and/or deductible amount for SARCLISA. It is not an insurance benefit. The CareASSIST Copay Program reserves the right to rescind, terminate, or amend this offer, eligibility, and terms and conditions at any time without notice. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. This offer is not conditional on any past, present, or future purchase, including refills. This offer is nontransferable, limited to one per person, and cannot be combined with any other offer or discount. This program is not valid where prohibited by law, taxed, or restricted. Offer has no cash value. Program is not valid for cash-paying customers. Additional program conditions may apply.