IncyteCARES for OPZELURA Patient Assistance Program
The IncyteCARES for OPZELURA Patient Assistance Program provides OPZELURA at no cost to eligible patients in need.* You may be eligible if you are uninsured or have Medicare Part D coverage.
You are considered uninsured if you have no prescription insurance. If you have medical insurance, it may not cover OPZELURA. If you are unsure, you can call your doctor or your health plan.
The IncyteCARES for OPZELURA Patient Assistance Program provides OPZELURA at no cost to eligible patients in need.* You may be eligible if you are uninsured or have Medicare Part D coverage.
You are considered uninsured if you have no prescription insurance. If you have medical insurance, it may not cover OPZELURA. If you are unsure, you can call your doctor or your health plan.
To be eligible for the Patient Assistance Program, you must:
- Be uninsured or have Medicare Part D coverage and cannot afford your copay
- Have a valid prescription for OPZELURA for mild to moderate eczema
- Have an adjusted annual household income that is less than or equal to 400% of the Federal Poverty Level
The table below shows who might qualify for the Patient Assistance Program
If this many people live | You may qualify if your full-year income |
---|---|
1 person | $58,320 |
2 people | $78,880 |
3 people | $99,440 |
4 people | $120,000 |
5 people | $140,560 |
If you live in Alaska or Hawaii or have a household with more than 5 members, please call IncyteCARES for OPZELURA at 1-800-583-6964 to see if you may qualify.
Income levels are subject to change on an annual basis; the numbers in this table are based on the 2023 Federal Poverty Level Guidelines.
Additional eligibility criteria if you have Medicare Part D coverage:
- You must be enrolled in a Medicare Part D prescription insurance plan and have expressed and documented an inability to afford your out-of-pocket cost
You must not be a beneficiary of any of these government insurance or healthcare programs including, but not limited to: - Medicaid
- Medicare Part D Low-Income Subsidy (LIS) program
- Veterans Affairs (VA)
- Department of Defense (DoD)
- TRICARE
- Any State Patient Assistance Program (SPAP)
How it works
GETTING
STARTED
If you are eligible for the Program, your doctor will need to complete and submit the Prescription and Enrollment Form for OPZELURA. You will need to sign the form and provide proof of your household income.
If you are uninsured and eligible for the Program, you will be enrolled up to 12 months. After 12 months of being enrolled in the Program, you must apply to be re-enrolled.
If you have Medicare Part D coverage and you’re eligible for the Program, you will be enrolled for the calendar year and must re-enroll each year.
If you are eligible for the Program, your doctor will need to complete and submit the Prescription and Enrollment Form for OPZELURA. You will need to sign the form and provide proof of your household income.
If you are uninsured and eligible for the Program, you will be enrolled up to 12 months. After 12 months of being enrolled in the Program, you must apply to be re-enrolled.
If you have Medicare Part D coverage and you’re eligible for the Program, you will be enrolled for the calendar year and must re-enroll each year.
PROVIDING PROOF
OF INCOME
To qualify for the Program, IncyteCARES will need to verify your household income. You can either:
- Sign the Electronic Income Verification section on the Prescription and Enrollment Form and IncyteCARES will verify your income electronically
- OR
- Submit your most recent federal income tax return (Form 1040), your most recent W-2 earnings statement from your employer, your most recent Social Security Benefit Verification Letter, or one month of your recent pay stubs
To submit the required documentation, you can either give it to your doctor to fax with your Program application or mail it separately to IncyteCARES for OPZELURA PAP, 6000 Park Lane, Pittsburgh, PA 15275.
To qualify for the Program, IncyteCARES will need to verify your household income. You can either:
- Sign the Electronic Income Verification section on the Prescription and Enrollment Form and IncyteCARES will verify your income electronically
- OR
- Submit your most recent federal income tax return (Form 1040), your most recent W-2 earnings statement from your employer, your most recent Social Security Benefit Verification Letter, or one month of your recent pay stubs
To submit the required documentation, you can either give it to your doctor to fax with your Program application or mail it separately to IncyteCARES for OPZELURA PAP, 6000 Park Lane, Pittsburgh, PA 15275.
GETTING YOUR
MEDICATION
If you are eligible for the Patient Assistance Program, OPZELURA will be shipped to you from the designated Program pharmacy.
If you are eligible for the Patient Assistance Program, OPZELURA will be shipped to you from the designated Program pharmacy.
PRESCRIPTION
REFILLS
You will receive a call from the designated Program pharmacy to refill your prescription for OPZELURA. If you have any questions regarding refills for your medication, please call IncyteCARES for OPZELURA at 1-800-583-6964.
You will receive a call from the designated Program pharmacy to refill your prescription for OPZELURA. If you have any questions regarding refills for your medication, please call IncyteCARES for OPZELURA at 1-800-583-6964.
*
Terms and Conditions apply. Terms of this Program may change at any time.
Call IncyteCARES for OPZELURA