Program Details
REGENERON PHARMACEUTICALS, INC.
Libtayo Surround Program
Libtayo injection
(cemiplimab-rwlc)
|
| CONTACT
INFO |
|
| Address: |
PO Box 220262
Charlotte, NC 28211-0262 |
| Phone: |
1-877-542-8296 |
Provider Phone: |
|
| Fax: |
1-833-853-8362 |
Website: |
Program Website |
|
| ELIGIBILITY
|
|
| Eligibility
Info: |
Patient must meet income requirements and are uninsured, lack coverage for LIBTAYO, or have Medicare Part B with no supplemental insurance coverage.
Patients with Medicare Part D are not eligible.
Program also provides co-pay and reimbursement assistance. |
| Income at or below: |
Single |
|
500
% FPL |
| |
Couple |
|
500
% FPL |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Not
Published |
| US citizenship/residency specified:
|
Yes |
|
|
APPLICATION |
|
| Attachments
Required: |
Not Published
|
Physician
License #
Required: |
Both DEA and State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
| MEDICATION |
|
| Receives: |
Varies
|
| Shipped To: |
Provider
|
| Quantity in
Shipment: |
Varies |
| Delivery Time: |
Not Published
|
| Re-application
Policy: |
New application every 12 months
|
| Refill Policy: |
Refill form sent with each supply |
| Other Information: |
|
|
|
Last Updated: 11/21/2023
www.RxAssist.org
|