START, STAY, AND SAVE WITH FASENRA

With the FASENRA Savings Program, your eligible commercially insured patients can start and stay on FASENRA regardless of coverage. Patients may pay as little as $0 for FASENRA and its injection administration.

FASENRA Savings Coupon FASENRA Savings Coupon

Eligible patients may pay as little as $0* for FASENRA and its injection administration.

To be eligible, patients must:

  • Have commercial insurance
  • Have FASENRA approved by their insurance plan

*Up to $10,000 per year for both drug and injection administration.

SUBMIT AN APPEAL

FASENRA Savings Coupon FASENRA Savings Coupon

SUBMIT AN APPEAL

APPEAL IS APPROVED

Eligible patients may pay as little as $0* for FASENRA and its injection administration.

To be eligible, patients must:

  • Have commercial insurance
  • Have FASENRA approved by their insurance plan

*Up to $10,000 per year for both drug and injection administration.


FASENRA Savings Coupon

APPEAL IS DENIED

Patient pays $0 for FASENRA and its injection administration for up to 1 year.

To be eligible, patients must:

  • Have commercial insurance
  • Have had their prior authorization (PA) and PA appeal denied by their insurance company
  • Have FASENRA prescribed for on-label use

Enrollment is open through December 31, 2018. Patients who enroll receive support for 12 months from the date of initial prescription.

How the FASENRA Savings Program Works

The FASENRA Savings Program helps eligible commercially insured patients receive FASENRA for as little as $0 out-of-pocket for the medication and its injection administration through a Virtual Debit Card. Your role in the program will vary, depending on how your practice acquires FASENRA.

SPECIALTY PHARMACY

If acquiring FASENRA through a Specialty Pharmacy:

Out-of-pocket costs for FASENRA:

No action on your part is required. The pharmacy will enroll the patient into the FASENRA Savings Program and apply the program benefits to the patient’s out-of-pocket costs for FASENRA

Out-of-pocket costs for injection administration:

Patients are responsible for requesting reimbursement for out-of-pocket costs for injection administration. Reimbursement forms are available by contacting Access 360 at 1-833-360-HELP (1-833-360-4357) or to download click here

Out-of-pocket costs for FASENRA:

No action on your part is required. The pharmacy will enroll the patient into the FASENRA Savings Program and apply the program benefits to the patient’s out-of-pocket costs for FASENRA

Out-of-pocket costs for injection administration:

Patients are responsible for requesting reimbursement for out-of-pocket costs for injection administration. Reimbursement forms are available by contacting Access 360 at 1-833-360-HELP (1-833-360-4357) or to download click here

BUY & BILL

If buying FASENRA from a Specialty Distributor to administer to your patients:

  • 1. Create an account online at www.FASENRASavings.com. This is a one-time registration step and will only take a few minutes.
  • 2. Register your debit card/point-of-sale terminal. Call AstraZeneca Access 360™ at 1-833-360-4357 and a representative will walk you through this simple process.
  • 3. Enroll eligible patients at www.FASENRASavings.com

      It is highly recommended that you enroll your patients AFTER the PA is approved

    • After enrollment, you will receive a letter that contains patient-specific information and instructions on how to submit claims for reimbursement of FASENRA and its injection administration. Please retain this letter for future use
    • After administering FASENRA, submit a claim to your patient’s insurance. You will receive an Explanation of Benefits (EOB) that you can use to determine the exact amount your patient owes for FASENRA, including the injection administration
    • Submit request for reimbursement of your patient’s out-of-pocket cost of FASENRA and its injection administration at www.FASENRASavings.com and include a copy of the EOB. While the out-of-pocket costs for patients will vary, most eligible patients may pay as little as $0 per injection of FASENRA
    • After the FASENRA Savings Program claim has been reviewed and approved, you will be notified that the Virtual Debit Card associated with that patient has been loaded with the approved amount. Process a debit card transaction on the registered debit card terminal to retrieve the funds from the card

FASENRA Savings Program for Denied Patients

  • If a patient with commercial insurance has a FASENRA prescription for on-label use and their PA appeal has been denied by their insurance plan, FASENRA may be available at no cost through Diplomat Specialty Pharmacy.
  • To enroll a patient in the FASENRA Savings Program for Denied Patients:

    Call Access 360 at 1-833-360-4357 to obtain a Denied Patient Cover Sheet or to download click here

  • Complete and sign the Cover Sheet. Fax it with the original prescription, copies of the PA denial, and PA appeal denial to Diplomat Specialty Pharmacy at 1-866-376-1448
  • Patients in this program must get FASENRA from Diplomat Specialty Pharmacy

  • You will be notified that the information has been received within 2 business days
  • While the out-of-pocket costs for patients will vary, most eligible patients may pay as little as $0 per injection of FASENRA

Eligibility

Your patient may be eligible for this offer if they are insured by commercial insurance.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If patients are enrolled in a state or federally funded prescription insurance program, they may not use this program even if they elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

Terms of Use

Eligible commercially insured patients with a valid prescription for FASENRA who enroll in this program may pay as little as $0 per administration of FASENRA dependent upon patient’s prescription coverage of FASENRA.

If FASENRA is covered by your health plan:

  • Up to $10,000 per calendar year in assistance for out-of-pocket expenses

If FASENRA is not covered by your health plan:

  • Prescription fills for 12 months from the date of the initial prescription
  • A PA Denial and PA Appeal Denial by your health plan are required to be eligible for this program
  • FASENRA must be prescribed for on-label use to be eligible for this program
  • This program is only administered by approved specialty pharmacies

The out-of-pocket costs covered by the program can include the cost of the product itself and the cost of injection administration of the product (program maximum of $100 per injection administration).ठOther restrictions may apply. Patient must be enrolled in the program before use. If you have any questions regarding the offer, please call 1-833-360-HELP (1-833-360-4357).

Offer is invalid for claims or transactions more than 180 days from the date of service.

Non-transferable, limited to one person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for FASENRA at the time of purchase.

Patients must have commercial health insurance.

Program covers the cost of the drug and administration, and does not cover the costs for office visits or any other associated costs.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Patients are responsible for any cost associated with the administration above the $100 per injection administration assistance provided by the program.

§Patients who are residents of Massachusetts, Michigan, Minnesota, or Rhode Island are not eligible for injection administration assistance.

Eligibility

Your patient may be eligible for this offer if they are insured by commercial insurance.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If patients are enrolled in a state or federally funded prescription insurance program, they may not use this program even if they elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

Terms of Use

Eligible commercially insured patients with a valid prescription for FASENRA who enroll in this program may pay as little as $0 per administration of FASENRA dependent upon patient’s prescription coverage of FASENRA.

If FASENRA is covered by your health plan:

  • Up to $10,000 per calendar year in assistance for out-of-pocket expenses

If FASENRA is not covered by your health plan:

  • Prescription fills for 12 months from the date of the initial prescription
  • A PA Denial and PA Appeal Denial by your health plan are required to be eligible for this program
  • FASENRA must be prescribed for on-label use to be eligible for this program
  • This program is only administered by approved specialty pharmacies

The out-of-pocket costs covered by the program can include the cost of the product itself and the cost of injection administration of the product (program maximum of $100 per injection administration).ठOther restrictions may apply. Patient must be enrolled in the program before use. If you have any questions regarding the offer, please call 1-833-360-HELP (1-833-360-4357).

Offer is invalid for claims or transactions more than 180 days from the date of service.

Non-transferable, limited to one person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for FASENRA at the time of purchase.

Patients must have commercial health insurance.

Program covers the cost of the drug and administration, and does not cover the costs for office visits or any other associated costs.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

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IMPORTANT SAFETY INFORMATION

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CONTRAINDICATIONS  Known hypersensitivity to benralizumab or excipients.

Warnings and Precautions

Hypersensitivity Reactions  Hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria, rash) have occurred after administration of FASENRA. These reactions generally occur within hours of administration, but in some instances have a delayed onset (ie, days). Discontinue in the event of a hypersensitivity reaction.

IMPORTANT SAFETY INFORMATION

Contraindications

Known hypersensitivity to benralizumab or excipients.

Warnings and Precautions

Hypersensitivity Reactions

Hypersensitivity reactions (eg, anaphylaxis, angioedema, urticaria, rash) have occurred after administration of FASENRA. These reactions generally occur within hours of administration, but in some instances have a delayed onset (ie, days). Discontinue in the event of a hypersensitivity reaction.

Acute Asthma Symptoms or Deteriorating Disease

FASENRA should not be used to treat acute asthma symptoms, acute exacerbations, or acute bronchospasm.

Reduction of Corticosteroid Dosage

Do not discontinue systemic or inhaled corticosteroids abruptly upon initiation of therapy with FASENRA. Reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Parasitic (Helminth) Infection

It is unknown if FASENRA will influence a patient’s response against helminth infections. Treat patients with pre-existing helminth infections before initiating therapy with FASENRA. If patients become infected while receiving FASENRA and do not respond to anti-helminth treatment, discontinue FASENRA until infection resolves.

Adverse Reactions

The most common adverse reactions (incidence ≥ 5%) include headache and pharyngitis.

Injection site reactions (eg, pain, erythema, pruritus, papule) occurred at a rate of 2.2% in patients treated with FASENRA compared with 1.9% in patients treated with placebo.

Use in Specific Populations

The data on pregnancy exposure from the clinical trials are insufficient to inform on drug-associated risk. Monoclonal antibodies such as benralizumab are transported across the placenta during the third trimester of pregnancy; therefore, potential effects on a fetus are likely to be greater during the third trimester of pregnancy.

INDICATION

FASENRA is indicated for the add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype.

  • FASENRA is not indicated for treatment of other eosinophilic conditions
  • FASENRA is not indicated for the relief of acute bronchospasm or status asthmaticus

Prescribing Information including Patient Information.

You may report side effects related to AstraZeneca products by clicking here.

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 3. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 4. Data on file, REF-19697, AZPLP. 5. Pham TH, Damera G, Newbold P, Ranade K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respir Med. 2016;111:21-29.

*The pharmacodynamic response (blood eosinophil depletion) following repeat SC dosing was evaluated in asthma patients in a 12-week phase 2 trial. Patients received 1 of 3 doses of benralizumab [25 mg (n=6), 100 mg (n=6), or 200 mg (n=6) SC] or placebo (n=6) every 4 weeks for a total of 3 doses. Twenty-hours post dosing, all benralizumab dosage groups demonstrated complete or near complete depletion of blood eosinophil levels, which was maintained throughout the dosing period.1,2

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Pham TH, Damera G, Newbold P, Ranade K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respir Med. 2016;111:21-29.

*The pharmacodynamic response (blood eosinophil depletion) following repeat SC dosing was evaluated in asthma patients in a 12-week phase 2 trial. Patients received 1 of 3 doses of benralizumab [25 mg (n=6), 100 mg (n=6), or 200 mg (n=6) SC] or placebo (n=6) every 4 weeks for a total of 3 doses. Twenty-four hours post dosing, all benralizumab dosage groups demonstrated complete or near complete depletion of blood eosinophil levels, which was maintained throughout the dosing period.1,2

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Pham TH, Damera G, Newbold P, Ranade K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respir Med. 2016 Feb;111:21-29.

GINA=Global Initiative for Asthma; ICS=inhaled corticosteroids; LABA=long-acting β2-agonists; OCS=oral corticosteroids; SOC=standard of care.

In Trials 1 and 2, FASENRA and placebo were administered plus standard of care (SOC), which is defined as high-dose (Trial 1) to medium- to high-dose (Trial 2) ICS/LABA (inhaled corticosteroids/long-acting β2-agonist) with or without other controllers, including systemic steroids. In Trial 3, FASENRA and placebo were administered in addition to daily OCS (7.5 to 40 mg) plus SOC, which is defined as high-dose ICS/LABA with or without other controllers.1

While 2 dosing regimens were studied in all 3 trials, the recommended dosing regimen is FASENRA administered every 4 weeks for the first 3 doses, then every 8 weeks thereafter.1

*The primary analysis population in Trial 1 was 267 for FASENRA + SOC and 267 for the placebo + SOC arm. In Trial 2, the primary analysis population for FASENRA + SOC and placebo + SOC was 239 and 248, respectively.1

A clinically significant exacerbation was defined as worsening of asthma requiring use of steroids for at least 3 days, and/or emergency department visits requiring use of steroids and/or hospitalization. For patients on maintenance OCS, an exacerbation was defined as a temporary increase in stable oral/systemic corticosteroids for at least 3 days or a single depo-injectable dose of corticosteroids.1

Atopic status for the placebo groups in Trials 1, 2, and 3 was 57%, 65%, and 49%, respectively.2,3,9

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 3. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 4. Nucala [package insert]. Research Triangle Park, NC: GlaxoSmithKline LLC; December 2017. 5. Cinqair [package insert]. Frazer, PA: Teva Pharmaceuticals, LLC; May 2016. 6. Bleecker ER, FitzGerald JM, Chanez P, et al. Appendix to: Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 7. FitzGerald JM, Bleecker ER, Nair P, et al. Appendix to: Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 8. Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448-2458. 9. Nair P, Wenzel S, Rabe KF, et al. Supplementary Appendix to: Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448-2458. 10. Nair P, Wenzel S, Rabe KF, et al. Protocol for: Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448-2458. 11. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2017. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed December 5, 2017.

FEV1=forced expiratory volume in 1 second; GINA=Global Initiative for Asthma; ICS=inhaled corticosteroids; IgE=immunoglobulin E; LABA=long-acting β2-agonists; LTRA=leukotriene receptor antagonists; OCS=oral corticosteroids; PRN=as required; SABA=short-acting β2-agonists.

Reference: 1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2017. http://ginasthma.org/2017-gina-report-global-strategy-for-asthma-management-and-prevention/. Accessed November 30, 2017.

References: 1. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 2. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 3. Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448-2458. 4. Pham TH, Damera G, Newbold P, Ranade K. Reductions in eosinophil biomarkers by benralizumab in patients with asthma. Respir Med. 2016;111:21-29.

*Annual exacerbation rate (AER) was defined as the total number of exacerbations multiplied by 365.25, divided by the total duration of follow-up (days) within the treatment group.

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 3. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 4. Nair P, Wenzel S, Rabe KF, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376:2448-2458.

FASENRA and placebo were administered plus standard of care (SOC), which is defined as high-dose ICS/LABA (inhaled corticosteroids/long-acting β2-agonist) with or without other controllers, including systemic steroids.1

*Statistical significance for FEV1 improvement was established at end of treatment. Week 4 results were descriptive only. FASENRA demonstrated greater improvements in change from baseline in pre-bronchodilator FEV1 compared with placebo at Week 4 (first measured time point after administration of treatment dose) that were maintained through end of treatment.2-4

The analyses of these endpoints were not multiplicity protected. Therefore, P values are reported as nominal. Results are descriptive only.

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Bleecker ER, FitzGerald JM, Chanez P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 3. Data on File, REF-19697, AZPLP. 4. FitzGerald JM, Bleecker ER, Nair P, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141. 5. Bleecker ER, FitzGerald JM, Chanez P, et al. Appendix to: Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388:2115-2127. 6. FitzGerald JM, Bleecker ER, Nair P, et al. Appendix to: Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388:2128-2141.

*Pharyngitis was defined as follows: pharyngitis, pharyngitis bacterial, viral pharyngitis, and pharyngitis streptococcal.

Hypersensitivity reactions were defined as follows: urticaria, urticaria papular, and rash.

Reference: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017.

Xolair is a registered trademark of Novartis AG; Nucala is a registered trademark of the GSK group of companies; Cinqair is a registered trademark of Teva Pharmaceutical Industries Ltd.

References: 1. FASENRA [package insert]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; December 2017. 2. Xolair [package insert]. Genentech, Inc. and Novartis Pharmaceuticals Corporation; June 2017. 3. Nucala [package insert]. Research Triangle Park, NC: GlaxoSmithKline LLC; December 2017. 4. Cinqair [package insert]. Frazer, PA: Teva Pharmaceuticals, LLC; May 2016.