Frequently Asked Questions
for ZYNYZ® (retifanlimab-dlwr)

Yes, an IncyteCARES team member can coordinate with your infusion center to ensure that your ZYNYZ is delivered and ready when you need it.

Call IncyteCARES about any insurance changes, and we can help you understand your new coverage. We can also determine if you are now, or are still, eligible for our IncyteCARES Savings Program or eligible for other forms of support.

Yes, once we have your prescription and insurance information and you are enrolled in IncyteCARES, an IncyteCARES program representative will call you to go over your coverage and costs for your medication. Call IncyteCARES at 1-855-452-5234, Monday through Friday, 8 AM–8 PM ET if you have questions.

Once we receive your insurance information, we can research your coverage for ZYNYZ right away. In most cases, we’ll call you with this information within 3 business days. If there is a delay, we’ll notify you and/or your Healthcare Professional within that time frame.

Once you are enrolled in IncyteCARES, a team member will contact your insurance company to determine your coverage for ZYNYZ and whether prior authorization is required. If prior authorization is needed, we will notify your doctor and ensure that the required information is sent to your insurance company.

A team member will contact you after you are enrolled in IncyteCARES. They will review your insurance coverage for ZYNYZ with you and will also explain any savings or financial assistance programs for which you may be eligible. You can also call IncyteCARES at 1-855-452-5234, Monday through Friday, 8 AM–8 PM ET to speak one-on-one to an IncyteCARES representative if you have questions.

Patients who have Medicare Part B or Medicaid may be eligible to receive ZYNYZ free of charge through the IncyteCARES Patient Assistance Program as long as they meet household income requirements and other criteria.* This program helps eligible patients who do not have health insurance or have trouble affording their out-of-pocket costs for their medication. Call IncyteCARES at 1-855-452-5234, Monday through Friday, 8 AM–8 PM ET to find out more.

*Terms and conditions apply. Terms of this program may change at any time.

Many insurance plans require prior authorization before they will approve coverage for ZYNYZ. This means they require your Healthcare Professional to send them additional information about your condition and why ZYNYZ is being prescribed. Based on the additional details, they will determine coverage. In most cases, this extra step delays their coverage approval by just a few days.

Please contact IncyteCARES if your insurance coverage changes or is lost or if you have a life-changing event such as a job loss or other change in household income. We can determine any changes in your coverage for ZYNYZ or your out-of-pocket costs. We can also find out if your specialty pharmacy is still within network for your insurer and can communicate any changes to them. If you need to change specialty pharmacies, we can help with that as well.

If your coverage for ZYNYZ is denied, IncyteCARES can help you and your doctor file an appeal. If your appeal is unsuccessful, we can assess your eligibility for free medication through the Patient Assistance Program.

Copay adjustment programs are used by health insurance companies—mostly for specialty medications that have drug manufacturer copay savings programs. Health plans use adjustment programs to offset what they pay for a medication rather than allow the manufacturers’ savings program to be applied to the patient's out-of-pocket costs and deductibles as it was intended to be.

As drug manufacturers attempt to create programs to subsidize out-of-pocket costs for patients, the payers reduce the value of these programs by exhausting such funds while also requiring the patient to pay their deductibles and coinsurance up to their out-of-pocket maximums to obtain their medications.

Copay adjustment programs may vary in name, but traditionally they are called copay accumulators or maximizers. Patients may often have difficulty knowing if their health insurance program includes accumulators and maximizers. In some cases, patients are offered reduced costs if they enroll in a particular program.

The most common types of copay adjustment programs are accumulators and maximizers. These programs are designed to exclude the use of manufacturer copay savings programs from counting toward patients’ annual deductibles and out-of-pocket costs, such as copays.

• An accumulator adjustment program is used by the plan/pharmacy benefit managers (PBMs) to prevent manufacturers’ copay savings from being applied to deductibles and maximum out-of-pocket cost. That means that the value of the copay savings program goes directly to the plan rather than being subtracted from the patient’s annual deductible or out-of-pocket expenses. Once the full value of the copay savings is used, the patient is still responsible for their full or remaining deductible and out-of-pocket cost
• A maximizer adjustment program is used to adjust the patient’s copay responsibility to match the maximum value of the manufacturer’s savings program. Generally, the value is divided over the year, a shorter specified period of time determined by the plan, or the number of months a patient is on the product within a calendar year to extract the full value of the copay savings program. For plans to use maximizers, the insurance company deems the specialty drug nonessential so that they are not limited to the Affordable Care Act (ACA) maximums

First, take a look at your plan details. The explanation of benefits (EOB) report is a good place to start.

Your health insurance company can provide your EOB upon request. The document should describe how to meet your deductible and out-of-pocket maximum. You can also ask your employer if your plan includes these programs.

Next, review your insurance plan’s Pharmacy Limitations and Exclusions or Schedule of Benefits statement.

Be on the lookout for terms like “manufacturer,” “copay card,” “coupon,” and “discount.” These keywords can help you find the restrictions or limitations for financial assistance you may receive from drug manufacturers.

You can contact a customer service agent from your insurance company who may help you find out if the plan you are enrolled in (or are considering) has a copay adjustment program that could change your out-of-pocket costs.

Straightforward questions to ask include:

• Does this health plan have an accumulator or maximizer program?
• How does it impact me?
• What are my options for handling gaps in coverage that may occur?
• Am I required to enroll, or may I opt out?
• If I can opt out, can I do so at any time of the year or only during open enrollment?

Alternate funding programs (AFPs) are not medical insurance, but they can be used by health plans to deny or delay patients’ access to specialty medications. AFPs operate in agreement on behalf of the health plan to exclude certain specialty products from the patient’s prescription drug benefit. AFPs then coordinate with the patient’s enrollment into the drug manufacturer’s foundation or Patient Assistance Program (PAP). AFPs may create challenges and delays for starting or staying on therapy due to the PAP’s enrollment processes and timelines. AFPs may prevent a patient from moving through their insurance out-of-pocket requirements in the way the patient would have if the medication had been included in the insurer’s prescription drug benefit.