Specify Prescription Information
All information is required unless otherwise indicated.
Verify Copay Eligibility
All information is required unless otherwise indicated.
Based on the questions answered above, you are not eligible to register for a new copay or to activate a copay card.
The DUPIXENT MyWay® Patient Assistance Program may be able to help. Patients will need to meet the eligibility criteria, including household income, to qualify. The DUPIXENT MyWay team can research each patient’s situation and determine eligibility.
For more information or to enroll in the patient support program, contact at:
1‑844‑DUPIXENT (1-844-387-4936), option 1
Monday-Friday, 8 am - 9 pm EST
Although you are not eligible, you can sign up for DUPIXENT MyWay emails about DUPIXENT below.
Copay Card Information
All information is required unless otherwise indicated.
Contact Information
All information is required unless otherwise indicated.
Patient Information
Caregiver Information
Communications Preferences
All information is required unless otherwise indicated.
Additional Communication Considerations:
I acknowledge that by checking the Text Messaging Consent box, I expressly consent to receive text messages from or on behalf of the Program at the mobile telephone number(s) that I provide. I confirm that I am the subscriber for the mobile telephone number(s) provided, and I agree to notify Sanofi promptly if any of my number(s) change in the future. I understand that my wireless service provider's message and data rates may apply. I understand that I can opt out from future text messages at any time by texting TEXTOUTSMSSTOPDNPSTOPSMSSTOP to 39771 from my mobile phone, and that I can get help for text messages by texting TEXTHELPSMSHELPDNPHELPSMSHELP to 39771. I also understand that additional text messaging terms and conditions may be provided to me in the future as part of an opt-in confirmation text message. I understand that my consent is not required as a condition of purchasing any goods or services from Regeneron Pharmaceuticals, Inc. or Sanofi. Message and data rates may apply.
View Terms and Conditions and Privacy Policy.
I am enrolling in the DUPIXENT MyWay Program (the "Program") and authorize Regeneron Pharmaceuticals, Inc., Sanofi US, and their agents (together the "Alliance") to provide me services under the program, and as may be added in the future. Such services include medication and adherence communications and support, medication dispensing support, coverage and financial assistance support, disease and medication education, injection training and other support services (the "Services").
I agree to my enrollment in the DUPIXENT MyWay Copay Card program if confirmed as eligible, understand that copay card information will be sent to my designated specialty pharmacy/in-network specialty pharmacy along with my prescription, and any assistance with my applicable cost-sharing or co-payment for DUPIXENT (dupilumab) will be made in accordance with the Program terms and conditions.
I authorize the Alliance to contact me by mail, telephone, or email, with information about the Program, moderate-to-severe asthma moderate-to-severe eczema (atopic dermatitis) chronic rhinosinusitis with nasal polyposis moderate-to-severe eczema (atopic dermatitis) and products, promotions, services and research studies, and to ask my opinion about such information and topics, including market research and disease-related surveys.
I further authorize the Alliance to de-identify my health information and use it in performing research, education, business analytics, marketing studies or for other commercial purposes. I understand that members of the Alliance may share identifiable health information with one another in order to de-identify it for these purposes and as needed to perform the Services or to send the communications listed above (the "Communications"). I understand and agree that the Alliance may use my health information for these purposes and may share my health information with my doctors, specialty pharmacies, and insurers.
I understand that I do not have to enroll in the Program or receive the Communications, and that I can still receive DUPIXENT, as prescribed by my physician. I may opt out of receiving Communications, individual support services offered by the Program, including the DUPIXENT MyWay Copay Card, or opt out of the Program entirely at any time by notifying a Program representative by telephone at 1-800-633-1610 or by sending a letter to Sanofi US Customer Service P.O. Box 5925 Mailstop 55A-220A Bridgewater, NJ 08807. I also understand that the Services may be revised, changed, or terminated at any time.
Questions or comments? Contact Sanofi US, or call 1-844-643-7346 to contact Regeneron Pharmaceuticals, Inc.
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