Copay Card Enrollment

SEE IF YOU ARE ELIGIBLE TO SAVE ON DUPIXENT

Fill out this form with a valid email address and see if you’re eligible for the DUPIXENT MyWay® Copay Card. Plus, get the latest information about DUPIXENT, exclusive tools, and resources to help you understand and manage your condition.

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Specify Prescription Information

All information is required unless otherwise indicated.

Verify Copay Eligibility

All information is required unless otherwise indicated.

You are eligible for a copay card!

We'll need to collect some additional information, including a valid email address to send your card once you're registered. Please continue to the next step.

Based on the questions answered above, you are not eligible to register for a new copay card 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 us 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.

Based on the questions answered above, you are not eligible to register for a new copay card or to activate a copay card.

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

COMMUNICATIONS PREFERENCES

All information is required unless otherwise indicated.

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 to 39771 from my mobile phone, and that I can get help for text messages by texting 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.

Please read all of this copy before submitting.

I am enrolling in DUPIXENT MyWay® and authorize Regeneron Pharmaceuticals, Inc., Sanofi US, and their agents (together the "Alliance") to provide me services which may 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.

I agree to my enrollment in the DUPIXENT MyWay® Copay Card program (“Program”) if confirmed as eligible, understand that copay card information will be sent to my designated 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.

The maximum annual patient benefit under the DUPIXENT MyWay® Copay Card Program is $13,000. Copay amounts after applying copay assistance may depend on the patient’s insurance plan and may vary. The Program is intended to help patients access DUPIXENT. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the Program. In those situations, the Program may change its terms in order to enable patients to realize the full benefits of the assistance available under the Program.

I authorize the Alliance to contact me by mail, telephone, or email, with information about DUPIXENT MyWay®, disease state and products, promotions, services and research studies, and to ask my opinion about such information and topics, including market research and disease-related surveys (together, the “Communications”).

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 individual support services or to send 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 DUPIXENT MyWay® or receive the Communications, and that I can still receive DUPIXENT injection, as prescribed by my physician. I may opt out of receiving Communications, individual support services, including the DUPIXENT MyWay® Copay Card, or opt out of DUPIXENT MyWay® entirely at any time by notifying a 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 DUPIXENT MyWay® reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms and conditions at any time without notice. Commercially insured patients with questions or concerns about deductible, copay, or coinsurance amounts or the ability to obtain DUPIXENT can contact the Copay Card Program helpline at 1-855-520-3765.

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Thanks for Signing Up for a ACTIVATING your DUPIXENT MyWay ® Copay Card.

Now that your card is activated, you can use it as proof of copay assistance. You can also use it to receive more information about DUPIXENT from the DUPIXENT MyWay support program. Be on the lookout for an email from your support team. If you need any additional copay support call 1-844-DUPIXENT (1-844-387-4936), option 1.

Now that you’ve signed up, you can use your card as proof of copay assistance.
You can also use it to receive more information about DUPIXENT from the
DUPIXENT MyWay support program. Be on the lookout for an email from our
support team with your copay card. If you need your copay card immediately or
require any additional copay support call 1‑844‑DUPIXENT (1-844-387-4936), option 1 .

Learn how DUPIXENT is Taken

DUPIXENT is a form of medicine called a biologic, and is taken as a subcutaneous injection under the skin. Explore more information on how DUPIXENT is taken.

See Instructions

Nurse Educators Are Here to Help

In addition to the training from your doctor, a DUPIXENT MyWay Nurse Educator can provide supplemental injection training, either online or over the phone with a training kit and training syringe or pen for practice.

For more information, dial
1‑844‑DUPIXENT
(1-844-387-4936), option 1
Monday-Friday, 8 am - 9 pm EST