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Benlysta gateway enrollment form

Benlysta gateway enrollment form 2026

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The document is a Services Form for patients seeking assistance with BENLYSTA (belimumab), including benefits verification, patient assistance programs, and co-pay support. It requires personal, insurance, diagnosis, and physician information to facilitate access to treatment. Patients must authorize the collection and disclosure of their medical information for reimbursement support. Uninsured patients may apply for a Patient Assistance Program (PAP) based on income verification.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is Belimumab the same as Benlysta?

Belimumab (Benlysta) Belimumab is an immunosuppressant drug approved by the FDA for the treatment of lupus and lupus nephritis in children and adults.

How to get BENLYSTA without insurance?

Insured and uninsured patients who need help paying for BENLYSTA can apply for the BENLYSTA Co-pay Assistance Program. The BENLYSTA Co-Pay Card can pay 100% of your out-of-pocket costs for BENLYSTA up to a total of $9,000 annually for eligible patients.

What happens if you miss a Benlysta injection?

If you give yourself this medication at home: If you miss a dose, take it as soon as you can. Then, resume dosing on the usual day you get your medication or start a new weekly dosing schedule from the day that the missed dose was given. If it is almost time for your next dose, take only that dose.

How much does Benlysta cost in Canada?

Table 5CDR Cost Comparison Table of Treatments for Adults With SLE Drug/ comparatorStrengthAverage annual drug cost ($) Belimumab (Benlysta) 200 mg/mL 21,933 120 mg/5 mL 400 mg/20 mL Single-use vials Year 1: 24,660 (14 doses) Year 2: 22,898 (13 doses) Antimalarial drugs Hydroxychloroquine (Plaquenil, generic) 200 mg 57 to 1158 more rows

Does Benlysta reduce inflammation?

In lupus, the immune system produces harmful antibodies that attack the bodys own tissues. Belimumab works by reducing the activity of a type of white blood cell called B-cells that produce the antibodies. This reduces the inflammation that causes the symptoms of lupus.

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What is BENLYSTA Gateway?

BENLYSTA Gateway is a centralized program that offers resources and services for patients and healthcare professionals to help guide them through the access and reimbursement process. Our Field Reimbursement Managers (FRM) are here. to assist you and your practice with information.

What is the phone number for BENLYSTA Gateway?

However, if youd like a helping hand, the BENLYSTA Cares Support Team can connect you to BENLYSTA Gateway to help you understand your cost and coverage options. Call 1-877-4-BENLYSTA (1-877-423-6597).

Benlysta gateway enrollment form 2026

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Is Belimumab the same as Benlysta?

How to get BENLYSTA without insurance?

What happens if you miss a Benlysta injection?

How much does Benlysta cost in Canada?

Does Benlysta reduce inflammation?

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What is BENLYSTA Gateway?

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