It is important that you complete all requested information and sign where indicated. This offer is not insurance and is not valid for mail order, or for patients under 18 years of age. Patients enrolled in a state or federally funded prescription insurance program may not use this savings card. However, it is important to understand that this list price may not be reflective of your cost for BRILINTA. BRILINTA is metabolized by CYP3A4/5. Find out how AstraZeneca helps translate groundbreaking science for tomorrow's medicines at www.astrazeneca.com/our-science.html. For people with Medicaid, the out-of-pocket costs*** range from $2.31-$3.06 per month. Not valid if reproduced. Updated September 09, 2014 Patient must be a resident of the US. As the fastest growing pharmacy program in the country, Prescription Hope can obtain Brilinta for individuals at the set price of $50.00 per month. Patient Assistance Program In Canada, our AstraZeneca Patient Assistance Program is available to patients in financial need who meet the eligibility requirements for select medications. BRILINTA is not expected to impact PF4 antibody testing for HIT, The most common adverse reactions (>5%) associated with the use of BRILINTA included bleeding and dyspnea, Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. The Patient Assistance Program provides medication at no cost to those who qualify. BRILINTA is used to lower your chance of having a heart attack or dying from a heart attack or stroke, but BRILINTA (and similar drugs) can cause bleeding that can be serious and sometimes lead to death. Approval criteria. **Out-of-pocket costs: All expenses that are not covered by your insurance, ***IQVIA Formulary Impact Analyzer (FIA) audit, 12 months ending December 2018, average based on 30 day Rx supply. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2020. For any questions regarding Change Healthcare online processing, please call the Help Desk 1-800-422-5604. Eligibility: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patient Assistance Program In Canada, our AstraZeneca Patient Assistance Program is available to patients in financial need who meet the eligibility requirements for select medications. This offer is good for the purchase of BRILINTA® manufactured for AstraZeneca Pharmaceuticals LP and lawfully purchased from an authorized retailer or distributor in the United States or its territories. Patient has diagnosis of either; unstable angina, non-ST elevation myocardial infarction, or ST elevation myocardial infarction AND A valid Other Coverage Code (eg, 1) is required. Every download will have a unique number, so please don't make duplicates of the same card. Resources. 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. Patient Assistance Connection Financial Eligibility (for uninsured or … 4. There are four main programs offered by AstraZeneca for people who can’t afford to buy prescription medications on their own. BRILINTA is indicated to reduce the risk of a first MI or stroke in patients with coronary artery disease (CAD) at high risk for such events. This product information is intended for US Health Care Professionals only. Stopping BRILINTA increases the risk of subsequent cardiovascular events; B. ASPIRIN DOSE AND BRILINTA EFFECTIVENESS IN PATIENTS WITH ACS. Patients must list all sources of current income and attach documentation as described below. Patient contacts pharmacy: Limit: Maximum of 12 times in one year: Re-application: Request a new card after one year : Additional Information: Closed Program Eligible patients can save up to $75 a month for up to 12 months on their Brilinta copay costs. If you would like additional information regarding AstraZeneca products, please contact the Information Center at AstraZeneca at: 1-800-236-9933, Monday through Friday, 8 am to 6 pm ET, excluding holidays. FAQs Program Details ASTRAZENECA PHARMACEUTICALS AZ & Me Prescription Savings Program for people with Medicare Brilinta Tablets (ticagrelor) CONTACT INFO: Address: PO Box 222178 Charlotte, NC 28222 : Phone: 1-800-292-6363: Provider Phone: Fax: Visit program website: Website: AZ & Me Website: … Who is eligible for Patient Assistance Programs? Most programs also require your health provider to fill out a form. Please fill in all of the information. See eligibility rules and restrictions. Therapeutic area - Anticoagulants. No. However, the process and eligibility requirements to get into this program will vary from one company to another. N Engl J Med. Some common requirements are: Be a U.S. citizen or legal resident ; Have no prescription insurance coverage ; Meet program income guidelines; Can I apply for assistance if I have insurance or prescription coverage? Intended for US audiences only. Sahlén A, Varenhorst C, Lagerqvist B, et al. Bonaca MP, Bhatt DL, Cohen M, et al, for the PEGASUS-TIMI 54 Steering Committee and Investigators. Use BRILINTA with a loading dose of aspirin (300 to 325 mg). Patient Assistance Program Center: Search Database. ... Read More. In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Patient Assistance Program. Review our medicine list and download the application to apply. Bausch Health Patient Assistance Program will reconfirm continued income and insurance eligibility annually. Long-term use of ticagrelor in patients with prior myocardial infarction. When possible, interrupt therapy with BRILINTA for, Ticagrelor can cause ventricular pauses. BRILINTA can also decrease your risk of blood clots in your stent in people who have received stents for the treatment of ACS. Territory. For information on eligibility for: Coupons and Free Trial Offers. Updated January 04, 2017. For any questions regarding Change Healthcare online processing, please call the Help Desk 1-800-422-5604. Patients who remain eligible are automatically re-enrolled each year. PATIENT ASSISTANCE PROGRAM Dear Applicant, Thank you for your interest in the Arbor Pharmaceuticals, LLC. Reimbursement will be received from Change Healthcare. Assistance may range from reduced cost of drugs to free medicine. Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery ; If possible, manage bleeding without discontinuing BRILINTA. 2009;361(11):1045-1057 and Supplementary Appendix. Please contact the SolutionsPlus Access and Support Program 877-814-3915. Patient Assistance Program (PAP). BLEEDING RISK Once you apply and enroll, there may be limits on how much medication you can get or how long the program lasts. If you lost employer-provided health insurance that covered your AbbVie treatment and can no longer pay for Humira, please call: 1-800-448-6472. During this extraordinary time, Otsuka Patient Assistance Foundation, Inc. (OPAF) continues to assist patients that have been prescribed an Otsuka medication. Patient is responsible for applicable taxes, if any. Offer must be presented along with a valid prescription at the time of purchase. Patient must not have prescription drug coverage under a private insurance or government program, or receiving any other assistance to help pay for medicine. 3. … The patient is responsible for $0.00. ALPHAGAN® P (brimonidine … Dyspnea from BRILINTA is often, In patients being treated for coronary artery disease, discontinuation of BRILINTA will increase the risk of MI, stroke, and death. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. Get Started. Not required. Commercial insurance is sometimes referred to as "private insurance" and is typically provided by the company you work for. If you pay cash for your prescription, AstraZeneca will pay up to the first $100, and you will be responsible for any remaining balance, for each monthly prescription. Patient Savings Center - beta. Eligibility Requirements. If you do not meet the eligibility requirements for the Teva Cares Foundation Patient Assistance Programs, you may be eligible for assistance from other programs that we offer. No claim for payment can be made to ANY Third-Party Payer for product dispensed pursuant to this offer. No proof of income required; If approved, you will receive a free 90-day supply of insulin. BRILINTA is a registered trademark and AZ&Me is a trademark of the AstraZeneca group of companies. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg. 3. Ticagrelor in patients with stable coronary disease and diabetes. Box 52029, Phoenix, AZ 85072-2029 | Phone: 1-800-277-2254 | Fax: 1-855-817-2711 Dear Patient and Health Care Professional (HCP): Thank you for your interest in the Novartis Patient Assistance Foundation, Inc. To be eligible, a patient must: • Be a U.S. resident • Meet the income requirements Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. Eur Heart J. In fact, we’ve offered assistance programs for over 40 years, and we offer other programs and services to help people get the medicines they need. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product, Dyspnea was reported more frequently with BRILINTA than in patients treated with control agents. Brilinta Coupon 2021 - Pay as low as $5 - Manufacturer Offer. The list price for BRLINTA is $404.82* for a 30-day supply. ACUVAIL® (ketorolac tromethamine ophthalmic solution) 0.45% Download application form. Program Managed by ConnectiveRx, on behalf of Astrazeneca. Do not use BRILINTA in patients Maintain the benefit for as long as they’re prescribed BRILINTA *Eligible patients will pay as low as $5 for a 30-day supply subject to a maximum savings of $200 per 30-day supply. Steg PG, Bhatt DL, Simon T, et al; for the THEMIS Steering Committee and Investigators. Ticagrelor in patients with stable coronary disease and diabetes. At AstraZeneca, we believe it’s not enough for us to simply make medicines, we have to help ensure that the people who need our medicines have access to them. Please note: If you are a health care professional affiliated with an employer, institution, or committee, or practicing in a state that restricts what items you may receive from manufacturers, we ask that you not accept or download any restricted items from this site. You meet the eligibility income requirements for the medication(s). Brilinta Coupon 2021 - Pay as low as $5 - Manufacturer Offer. 2. For additional details about this offer, please visit www.brilinta.com. If you are … There are currently no generic alternatives to Brilinta. BRILINTA is a prescription medicine for adults used to: decrease your risk of death, heart attack, and stroke in people with a blockage of blood flow to the heart (acute coronary syndrome or ACS) or a history of a heart attack. This includes all income made by you and your dependents (such as you, your spouse, your children, your parents). Maximum savings per 30-day supply is $200. If you would like to send this page, just complete the form below and click SEND. Patients must meet qualifying income eligibility criteria. Although eligibility differs from program to program, they all have three specific criteria in common. ©2020 AstraZeneca. TEL: 800-292-6363 Languages Spoken: English, Spanish. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age. Patient Assistance Program commonly referred to as a PAP, is a program offered by pharmaceutical and medical supply manufacturers aimed at helping people who can’t afford health care to get their medications and supplies at zero or very low cost. BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE. This free prescription program is available to individuals who meet certain income requirements, don’t have insurance coverage, are being treated as an outpatient by a United States licensed doctor, and live in the United States or a U.S. Stopping BRILINTA increases the risk of subsequent cardiovascular events, BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. † If you have commercial insurance, you may be eligible. Nontransferable, limited to one per person, cannot be combined with any other offer. References: 1. Eligibility for Free Trial Offer for Medicare or Medicaid Patients: This offer is good for eligible patients purchasing up to a 30-day supply (up to 60 tablets) of BRILINTA® (ticagrelor) tablets and may not be used for any other product. Patients who are approved for the PAP may qualify to receive free diabetes medicine from Novo Nordisk. If you have any questions regarding this offer, please call 1-800-422-5604. PRALUENT® (alirocumab) Patient Assistance Program (PAP) Enrollment Form üI am a Medicare patient with prescription coverage, I meet the income restrictions described below, and I have an approved prior authorization or Fax complete and signed forms to 1-844-855-7278 or … Return to Medication Search : 2 Programs for Brilinta Tablets : AZ&Me Prescription Savings Program for People with Medicare Part D , Phone : 800-292-6363 Fax: Eligibility > The patient must have Medicare Part D, and have an income less than or equal to $30,000 for an individual (less than or equal to $40,000 for a couple.) Select IVR prompt (2) “To check the status of your last fill request.” If you’re unable to identify your delivery status utilizing the IVR, select the option to be connected to an AZ&Me team member who can provide additional assistance. PRALUENT® (alirocumab) Patient Assistance Program (PAP) Enrollment Form üI am a Medicare patient with prescription coverage, I meet the income restrictions described below, and I have an approved prior authorization or Fax complete and signed forms to 1-844-855-7278 or … The poverty guidelines are updated annually by the U.S. Department of Health and Human Services therefore the above household income guidelines may not reflect the most current information available. Void where prohibited by law, taxed or restricted. Pharmacist instructions for Commercially Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (eg, 8). Financial criteria for patient assistance In order to meet the financial eligibility criteria for receiving Sanofi medication at no cost, you must have an annual household income of ≤ 400% of the current Federal Poverty Level. Select IVR prompt (1) to request a refill for a non-refrigerated medication. MI=myocardial infarction; PEGASUS=Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin; PLATO=PLATelet inhibition and patient Outcomes; SWEDEHEART=Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies. Brilinta: View Coupon: AZ&Me Prescription Savings Program for people without insurance This program provides brand name medications at no or low cost: Provided by: AstraZeneca Pharmaceuticals: PO Box 222178 Charlotte, NC 28222. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. These days getting medications is not as easy as it sounds – or perhaps as easy as it should be. All rights reserved. Patients must meet qualifying income eligibility criteria. Steg PG, Bhatt DL, Simon T, et al; for the THEMIS Steering Committee and Investigators. If you have any questions regarding this offer, please call 1-800-422-5604. Nontransferable, limited to one per person, cannot be combined with any other offer. Product Name. You may be able to receive your BRILINTA for as low as $5 with our BRILINTA savings card program. Patients who remain eligible are automatically re-enrolled each year. See income requirements on the next page. 2019;381(14):1309-1320. CODES (6 days ago) brilinta coupon for uninsu. People all over the world are living longer, healthier and more productive lives thanks to innovative medicines developed by companies like AstraZeneca. BRILINTA is a P2Y12 platelet inhibitor indicated to reduce the rate of thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) (unstable angina, non-ST elevation myocardial infarction, or ST elevation myocardial infarction). You may report side effects related to AstraZeneca products by clicking here. BRILINTA is indicated to reduce the risk of cardiovascular death, myocardial infarction (MI), and stroke in patients with acute coronary syndrome (ACS) or a history of myocardial infarction. For Gilotrif, patient must not use this programs application. Patient Assistance Program Application, How to Get it, Hints and Tips Posted August 26, 2019 by Michael Chamberlain - See Editorial Guidelines. Find out if you may be eligible. $200 maximum savings limit applies; patient’s out-of-pocket expense may vary. Medicaid or Medicare Patients: You will receive one 30-day prescription free. 5. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age. If you do not meet the eligibility requirements for the Teva Cares Foundation Patient Assistance Programs, you may be eligible for assistance from other programs that we offer. Terms of Use: Eligible commercially insured patients with a valid prescription for BRILINTA® (ticagrelor) tablets who present this savings card at participating pharmacies will pay as low as $5 per 30-day supply. You must be a resident of the US. Approved patients are eligible to receive assistance for up to 12 months from the date of approval. Your annual income must be at or below a certain level. Based on your answers, you may be eligible for assistance from the Bayer US Patient Assistance Foundation. You must not be currently receiving prescription drug coverage under a private insurance or government program (excluding Medicare), or receiving any other assistance to help pay for medicine. Less than $70,320 $70,320 to $132,360 $132,360 to $198,200 $198,200 or more Patient assistance programs (PAPs) are programs created by drug companies, such as ASTRAZENECA PHARMACEUTICALS, to offer free or low cost drugs to individuals who are unable to pay for their medication. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients, In patients with Heparin Induced Thrombocytopenia (HIT): False negative results for HIT-related platelet functional tests, including the heparin-induced platelet aggregation (HIPA) assay, have been reported with BRILINTA. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. The recipient will receive an e-mail with a direct URL link to this page, along with a notification that you requested to send it. 4. References: 1. For people with Medicare Part D coverage, the average out-of-pocket cost*** is $42.13 per month. Wallentin L, Becker RC, Budaj A, et al; for the PLATO Investigators. $200 maximum savings limit applies; patient’s out-of-pocket expense may vary. Bausch Health Companies, Inc., in its sole discretion can determine your participation in the Bausch Health Patient Assistance Program. 3. CODES (4 days ago) With the Brilinta® $5 Savings Card, eligible commercially insured patients may pay as little as $5 for each 30-day supply of Brilinta®. This valuable educational brochure explains: Order copies of the patient brochure, speak to a live representative at 1-888-512-7454, 7 AM to 9 PM ET, 365 days a year. Allergan Patient Assistance Program Find out if your medicine is in the Allergan Patient Assistance Program. In patients with acute ischemic stroke or high-risk TIA, initiate treatment with a 180-mg loading dose of BRILINTA and then continue with 90 mg twice daily for up to 30 days. Novo Nordisk will check back with you (before your 90-day enrollment ends) to determine continued eligibility. 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. If you are uninsured or have Medicare Part D and still face affordability challenges, you may be eligible for our patient assistance program, AZ&Me. Insurance Status. The patient is responsible for the first $5 and the card pays up to the next $200 per 30-day supply; patient’s out-of-pocket expenses may vary. Bradyarrhythmias including AV block have been reported in the post-marketing setting. There is no registration charge or monthly fee for participating. AEROCHAMBER PLUS® FLOW-VU® aVHC Small/Medium Mask Download application form. Offer not valid where prohibited by law, taxed, or restricted. Above household income guidelines are valid for patients living in the 48 contiguous states, Guam, Puerto Rico, and the U.S. Virgin Islands. Patient Savings Center - beta . After one year administer 60 mg twice daily. Program Website A focus is on individuals who are enrolled into Medicare Part D, patients with no (or very limited) health insurance, and individuals who have been faced with an unexpected financial hardship or emergency. No claim for payment can be made to ANY Third-Party Payer for product dispensed pursuant to this offer. The card will cover up to $100 per 30-day supply. Patient Assistance Information. If you have private insurance you may be able to receive your BRILINTA for as low as $5 with our BRILINTA savings card program. 2019;381(14):1309-1320. Additional Resources. November 2011. Download a patient brochure. Please attach a copy of the patient’s most recent federal income tax return. In patients with CAD but no prior stroke or MI, administer 60 mg twice daily. Wallentin L, Becker RC, Budaj A, et al; for the PLATO Investigators. Phone:(888) 537-8277; website:www.getasapinfo.com. If you do not see a patient assistance program listed that meets your specific need, please contact us for more information at: 1-800-999-6673. Patient Assistance Program Center: Search Database. AstraZeneca is committed to providing assistance if you can’t afford your BRILINTA: Please click here to see Important Product Safety Information, including Boxed WARNINGS. Offer must be presented along with a valid prescription at the time of purchase. If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. You will need to submit forms like your taxes and residence status to prove your eligibility. The Novartis Patient Assistance Foundation, Inc. (NPAF) is committed to providing access to Novartis medications for those most in need. Brilinta Drugs- Brilinta (ticagrelor) [AstraZeneca]. Assistance can be extended to the end of 2020 for otherwise eligible patients who have been denied Medicaid coverage. Certain qualified patients or patients with an income up to 400% of the Federal Poverty Level (FPL) may be eligible for additional assistance through AkebiaCares. Instances of serious bleeding, such as internal bleeding, may require blood transfusions or surgery. Patient Assistance Foundation, Inc. Information P.O. MI=myocardial infarction; PEGASUS=Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin; PLATO=PLATelet inhibition and patient Outcomes; SWEDEHEART=Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies; THEMIS=Effect of Ticagrelor on Health Outcomes in DiabEtes Mellitus Patients Intervention Study; T2D=type 2 diabetes. The patient must provide information and proof of income. A coupon code will be sent to their phone; message and data rates may apply, If your patients fill their prescriptions through mail order, they can fill out this form or call 1-888-512-7454. Other restrictions may apply. GoodRx has partnered with InsideRx and AstraZeneca to reduce the price for this prescription. Pharmacist instructions for Medicare or Medicaid Patients: Submit this claim to Change Healthcare. Mail-Order Rebate for Commercially Insured and Cash-Paying Patients: ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Please read full Prescribing Information, including Boxed WARNINGS, and Medication Guide. If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient. Patient Center RxAssist can help you learn about ways to use pharmaceutical company programs and other resources to help reduce your medication costs. The BI Cares Patient Assistance Program is a charitable program provided by the Boehringer Ingelheim Cares Foundation (BI Cares), an independent nonprofit organization, to improve patients’ health and lives. For more information, please call 888-TEVA USA (838.2872), or Click here to find resources about other assistance programs: N Engl J Med. Patient is responsible for applicable taxes, if any. They can be reached at 1-855-727-6274, Monday-Friday, 8 AM-8 PM (ET). This offer is not conditioned on any past, present or future purchase, including refills. Diagnosis/Medical Criteria. Those with Part D Eligible? See eligibility rules and restrictions. Sahlén A, Varenhorst C, Lagerqvist B, et al. NeedyMeds is devoted to helping people in need find assistance programs to help them afford their medications and costs related to health care. For at least the first 12 months following ACS, it is superior to clopidogrel. Patients interested in this program should have their doctor's office contact our Medical Information Department at 1-800-668-6000 and ask for a Drug Request Form. AZ&Me™ is designed to help qualifying people without insurance and those on Medicare who are having trouble affording their AstraZeneca medications. Brilinta Coupon For Uninsured - Updated Daily 2020. Eur Heart J. AstraZeneca reserves the right to change or discontinue this offer at any time without notice. Patient must be a resident of the US. We encourage you to call our Dedicated Patient Case Coordinators to discuss your eligibility. You can place a refill for a patient already enrolled in the program by contacting our program at: (800) 292-6363. The treatment effect accrued early in the course of therapy. ACS=acute coronary syndrome; CV=cardiovascular; CODES (3 months ago) brilinta coupon for uninsured. Other restrictions may apply. Patient assistance programs are available to low-income individuals or families who are under-insured or uninsured and are provided to those who meet the eligibility guidelines. BRILINTA® (ticagrelor) [package insert]. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. Our goal is to invest our resources to help the most patients … Enclosed you will find the requested application. 2. The information printed below should be used when submitting for reimbursement.