If a clinically significant hypersensitivity reaction occurs, institute appropriate therapy and discontinue DUPIXENT.Ĭonjunctivitis and Keratitis: Conjunctivitis and keratitis occurred more frequently in atopic dermatitis subjects who received DUPIXENT versus placebo, with conjunctivitis being the most frequently reported eye disorder. Hypersensitivity: Hypersensitivity reactions, including anaphylaxis, serum sickness or serum sickness-like reactions, angioedema, generalized urticaria, rash, erythema nodosum, and erythema multiforme have been reported. © 2020 Sanofi and Regeneron Pharmaceuticals, Inc.ĬONTRAINDICATION: DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients. Need additional guidance with the enrollment process? Contact your field access specialist or call DUPIXENT MyWay. The DUPIXENT MyWay nurse connects patients to a variety of helpful resources, including one-on-one nursing support, financial assistance for eligible patients, and helpful refill and injection reminders. If the patient has consented, the patient’s nurse educator will initiate a welcome call with the patient within a few days after enrolling. Please note that you will receive a confirmation fax after sending the form. They will begin the benefits investigation and inform your office of the next steps. If your office does not use a preferred specialty pharmacy, leave the box unchecked to indicate that you would like DUPIXENT MyWay to conduct the benefits investigation on the patient’s behalf.įax the Enrollment Form with the unchecked box to DUPIXENT MyWay. This will allow the specialty pharmacy to conduct the benefits investigation, and DUPIXENT MyWay will provide additional support to the patient. If this is the case, write the preferred specialty pharmacy name and then check the box indicating that you have sent the prescription to the specialty pharmacy, which will be responsible for securing the coverage on the patient’s behalf.įax the Enrollment Form with the checked box to both the specialty pharmacy and DUPIXENT MyWay. Your office may choose to use a preferred specialty pharmacy to start the benefits investigation. Once the primary ICD-10 code is filled in and the form is completed, write the names of the patient and prescriber at the top of all pages.ĭUPIXENT MyWay complements your office’s process for accessing DUPIXENT. Be sure to provide only one ICD-10 code, even if the patient has comorbid disease. A list of potential codes is provided within the Enrollment Form for reference. Populate the clinical information corresponding to your patient’s diagnosis. Please inform patients that DUPIXENT MyWay will be contacting them through their preferred method of communication and that maintaining communication is important for them to receive support from DUPIXENT MyWay.Įnsure that the Healthcare Provider has read and agrees to the Healthcare Provider certification, and signs and dates the prescription at the bottom. To help ensure a seamless enrollment process, ask the patient if they would like to provide their email address, mobile phone number, and to consent to receiving text messages. Then, ensure the patient has signed and dated twice at the top of the form where indicated, as it is vital to the process that the patient reads and agrees to both the Patient Authorization and the Certifications. Please ensure that you are filling out the correct form that corresponds to the appropriate indication.įirst, allow the patient to review the Patient Authorization and Certifications. Putting the pieces together for acquiring DUPIXENT.Īfter you prescribe DUPIXENT, a correctly filled out DUPIXENT MyWay Enrollment Form helps ensure patient enrollments are processed without delays.įorms are available at.
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