How to enroll your patients in DUPIXENT MyWay

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Putting the pieces together for acquiring DUPIXENT.

After you prescribe DUPIXENT, a correctly filled out DUPIXENT MyWay Enrollment Form helps ensure patient enrollments are processed without delays.

Forms are available at DupixentHCP.com. Please ensure that you are filling out the correct form that corresponds to the appropriate indication.

First, allow the patient to review the Patient Authorization and Certifications. 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.

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.

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.

Ensure that the Healthcare Provider has read and agrees to the Healthcare Provider certification, and signs and dates the prescription at the bottom.

Populate the clinical information corresponding to your patient’s diagnosis. A list of potential codes is provided within the Enrollment Form for reference. Be sure to provide only one ICD-10 code, even if the patient has comorbid disease.

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.

DUPIXENT MyWay complements your office’s process for accessing DUPIXENT. Your office may choose to use a preferred specialty pharmacy to start the benefits investigation.

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.

Fax the Enrollment Form with the checked box to both the specialty pharmacy and DUPIXENT MyWay. This will allow the specialty pharmacy to conduct the benefits investigation, and DUPIXENT MyWay will provide additional support to the patient.

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.

Fax the Enrollment Form with the unchecked box to DUPIXENT MyWay. They will begin the benefits investigation and inform your office of the next steps.

Please note that you will receive a confirmation fax after sending the form.

If the patient has consented, the patient’s nurse educator will initiate a welcome call with the patient within a few days after enrolling. 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.

Need additional guidance with the enrollment process? Contact your field access specialist or call DUPIXENT MyWay.

© 2020 Sanofi and Regeneron Pharmaceuticals, Inc.
All Rights Reserved.

DUP.20.03.0269 05/2020

Complete and submit the DUPIXENT MyWay Enrollment Form.
Once enrolled, the DUPIXENT MyWay support program can help enable access to DUPIXENT and offer financial assistance for eligible patients, one-on-one nursing support, and more.
Coverage Support
  • Benefits Investigation
  • Prior Authorization
  • Appeals
Patient Access Support
  • Quick Start Program
  • Copay Card
  • Patient Assistance Program
Nursing Support
  • One-on-One Nurse Educator
  • Supplemental Injection Training

DUPIXENT MyWay
ENROLLMENT FORMS

FOR DERMATOLOGISTS
English Enrollment Form
Spanish Enrollment Form
FOR ALLERGISTS
Allergist (AD, Asthma, CRSwNP)
English Enrollment Form
Allergist (AD, Asthma, CRSwNP)
Spanish Enrollment Form
Allergist (EoE)
English Enrollment Form
Allergist (EoE)
Spanish Enrollment Form
FOR ENT SPECIALISTS/
PULMONOLOGISTS
English Enrollment Form
Spanish Enrollment Form
FOR GASTROENTEROLOGISTS
English Enrollment Form
Spanish Enrollment Form

Get a Quick Start

For patients with commercial insurance who are new to DUPIXENT and are experiencing a coverage delay, the DUPIXENT Quick Start program may be able to help with temporary access at no cost. Ask your Field Representative for additional information.

CoverMyMeds support is available for DUPIXENT

CoverMyMeds provides additional PA process-related support for DUPIXENT. Live support is available at 866-452-5017 or covermymeds.com.

For more information, dial 1‑844‑DUPIXENT 
(1-844-387-4936) option 1

Monday-Friday, 8 am - 9 pm ET