Patient support for eligible and enrolled patients prescribed Bylvay
For HCPs
For Patients/Caregivers
IPSEN CARES Enrollment Is Quick and Easy
Eligible Patients must be enrolled to access all lPSEN CARES support offerings.
Patient and HCPs can fill out the IPSEN CARES Enrollment Form at the office. The form can either be filled out online and then submitted electronically, or it can be printed and then faxed to IPSEN CARES.
Once a completed Enrollment Form is received, an IPSEN CARES Patient Access Manager will conduct a benefits verification to review the patient’s out-of-pocket costs associated with the Ipsen medication. Additional support offerings for which the patient may be eligible will be discussed at that time.
Help With Copays?
Commercially-insured patients may be eligible to receive copay assistance. Note that only prescribers and specialty pharmacies can register patients for this program.
Key Eligibility Criteria
- Your patient currently has commercial (private) health insurance that covers Bylvay.
- Your patient also has no primary or secondary insurance coverage under any state or federal healthcare program
- Your patient has US residency
- Your patient has a valid prescription for Bylvay.
This offer is not valid for cash-paying patients or patients currently enrolled in Medicare, Medicaid, or any other federal or state healthcare program. Limitations apply. Void where prohibited.
*Copay Assistance Program Patient Eligibility & Terms and Conditions: Patients are not eligible for copay assistance through IPSEN CARES® if they are enrolled in any state or federally funded programs for which drug prescriptions or coverage could be paid in part or in full, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE (collectively, “Government Programs”), or where prohibited by law. Patients must be United States residents (including its territories) and enrolled in IPSEN CARES® to receive copay program benefits. Patients receiving assistance through another assistance program or foundation, free trial, or other similar offer or program, are not eligible for the copay assistance program during the current enrollment year.
An annual calendar year maximum copay benefit applies.
Patients may remain enrolled in copay assistance as long as eligibility criteria is met.
Patients or guardians are responsible for reporting receipt of copay savings benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled through the program, as may be required. Additionally, patients or guardians may not submit any benefit provided by this program for reimbursement through a Flexible Spending Account, Health Savings Account, Health Reimbursement Account, or otherwise to a government or private payor. Ipsen reserves the right to rescind, revoke, or amend these offers without notice at any time. Ipsen and/or its copay assistance vendor are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Data related to patient participation may be collected, analyzed, and shared with Ipsen for market research and other purposes related to assessing the program. Data shared with Ipsen will be de-identified, meaning it will not identify the patient. Void outside of the United States and its territories or where prohibited by law, taxed, or restricted. This program is not health insurance. No other purchase is necessary. Copay assistance cannot be sold, purchased, traded, or counterfeited. Void if reproduced.
Patient Assistance Program
Patients may be eligible to receive free drug through our Patient Assistance Program if they are experiencing financial hardship and meet financial eligibility criteria, are uninsured or functionally uninsured, are residents of the U.S., and received a valid prescription for an on-label use of Bylvay as supported by information provided in the program application. Eligibility does not guarantee approval for participation in the program.
Please fill out an enrollment form, and ask your patient to fill out and sign the Supplemental Patient Assistance Program Form, if you’re interested to see if your patient qualifies.
Patient Assistance Program (PAP) Form
DownloadPatient Authorization
Patients are required to sign the Bylvay Patient Authorization Form every 3 years, or sooner if required by state law, to give the Patient Access Managers at IPSEN CARES permission to access the patient's personal health information in order to help with treatment. The form can be signed and submitted online, or by downloadable PDF, which must be printed, filled out, signed, and faxed.
IPSEN CARES Patient
Authorization Form
Spanish IPSEN CARES Patient Authorization Form
DownloadHelp With Copays?
The Bylvay Copay Assistance Program for eligible*, commercially insured and uninsured patients is available by enrolling in IPSEN CARES. Patients may pay as little as $0 per prescription.
Key Eligibility Criteria
- You currently have commercial (private) health insurance that covers Bylvay
- You also have no primary or secondary insurance coverage under any state or federal healthcare program
- You have US residency
- Patient has a valid prescription for Bylvay
This offer is not valid for cash-paying patients or patients currently enrolled in Medicare, Medicaid, or any other federal or state healthcare program. Limitations apply. Void where prohibited.
IPSEN CARES Copay
Assistance Flashcard
*Copay Assistance Program Patient Eligibility & Terms and Conditions: Patients are not eligible for copay assistance through IPSEN CARES® if they are enrolled in any state or federally funded programs for which drug prescriptions or coverage could be paid in part or in full, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE (collectively, “Government Programs”), or where prohibited by law. Patients must be United States residents (including its territories) and enrolled in IPSEN CARES® to receive copay program benefits. Patients receiving assistance through another assistance program or foundation, free trial, or other similar offer or program, are not eligible for the copay assistance program during the current enrollment year.
An annual calendar year maximum copay benefit applies. Patients may remain enrolled in copay assistance as long as eligibility criteria is met.
Patients or guardians are responsible for reporting receipt of copay savings benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled through the program, as may be required. Additionally, patients or guardians may not submit any benefit provided by this program for reimbursement through a Flexible Spending Account, Health Savings Account, Health Reimbursement Account, or otherwise to a government or private payor. Ipsen reserves the right to rescind, revoke, or amend these offers without notice at any time. Ipsen and/or its copay assistance vendor are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Data related to patient participation may be collected, analyzed, and shared with Ipsen for market research and other purposes related to assessing the program. Data shared with Ipsen will be de-identified, meaning it will not identify the patient. Void outside of the United States and its territories or where prohibited by law, taxed, or restricted. This program is not health insurance. No other purchase is necessary. Copay assistance cannot be sold, purchased, traded, or counterfeited. Void if reproduced.
Patient Education Liaison Support
You will be connected with a Patient Education Liaison (PEL). PELs are healthcare educators and are experienced in working with individuals living with certain conditions.
Your PEL:
- Can provide educational information to help you, your family, and caregivers better understand your condition, access needs, and treatment expectations.
- Will work with you to understand your specific situation and healthcare needs in alignment with the direction and advice provided by your healthcare provider.
- Will work in connection with your healthcare providers to support you and your caregivers through some of the many challenges of living with your condition.
Patient Assistance Program
Patients may be eligible to receive free drug through our Patient Assistance Program if they are experiencing financial hardship and meet financial eligibility criteria, are uninsured or functionally uninsured, are residents of the U.S., and received a valid prescription for an on-label use of Bylvay as supported by information provided in the program application. Eligibility does not guarantee approval for participation in the program.
Please fill out an enrollment form, as well as the Supplemental Patient Assistance Program, if you’re interested to see if you qualify.
Patient Assistance Program (PAP) Form
DownloadPatients and Healthcare Providers can also call IPSEN CARES at (866) 435-5677
