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Program Details

Sanofi and Regeneron Pharmaceuticals, Inc.
Dupixent MyWay Program

Dupixent (dupilumab injection)
 
CONTACT INFO
Address:
,
Phone: 1-844-387-4936 Provider Phone:
Fax: 1-844-387-3970 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • Patient must be uninsured or underinsured.
  • Patients with Medicare Part D should contact the program.
  • Program also providers co-pay assistance.
  • Income at or below: Not Published
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: No
    US citizenship/residency specified: Yes
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    NPI
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    Not Published
    MEDICATION
    Receives: Varies
    Shipped To: Patient
    Quantity in Shipment: Not Published
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    Refill Policy: Not Published
    Other Information:

    Last Updated: 06/15/2022

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    Document Dupixent Enrollment Form - ENT/Pumonologist


    Document Dupixent Enrollment Form - Dermatologists


    Document Dupixent Enrollment Form - Allergists


    Document Dupixent Enrollment Form - Gastroenterologists



     

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