Dupixent enrollment form 2022-2025

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Those who may qualify must be at least 18 years of age or older, a resident of the 50 United States, the District of Columbia, Puerto Rico, Guam or the USVI, and demonstrate a financial need with a total annual adjusted gross income of $100,000 or less.
DUPIXENT is indicated as an add-on maintenance treatment of adult and pediatric patients aged 6 years and older with moderate-to-severe asthma characterized by an eosinophilic phenotype or with oral corticosteroid dependent asthma [see Clinical Studies (14)].
Your insurance company may deny your prescription for Dupixent because it is not on the formulary list, or because they dont believe the drug is medically necessary for your condition.
You can obtain the appropriate PA form through DUPIXENT MyWay, CoverMyMeds, or your patients insurance provider or specialty pharmacy.
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