Gilead Sciences Zydelig AccessConnect

Patient Support Services Guide 2018


Zydelig AccessConnect
844-622-2377

Gilead Sciences’ Zydelig AccessConnect is a patient assistance program that offers ease of access and financial support for patients receiving treatment with Zydelig (idela­lisib) who are unable to afford the medication (Table).

Zydelig is indicated for the treatment of patients with relapsed chronic lymphocytic leukemia, in combination with rituximab; relapsed follicular B-cell non-Hodgkin lymphoma; or relapsed small lymphocytic lymphoma.

The Zydelig AccessConnect program assists patients across all insurance types.

Patient Assistance Programs

Uninsured patients may be eligible to receive Zydelig free of charge via the Zydelig AccessConnect Patient Assistance Program.

Copay Coupon Card

Patients with commercial or private insurance may qualify for copay assistance through the Copay Coupon Card.

For patients with government health insurance programs (eg, Medicare) who are underinsured, referrals to independent foundations capable of offering financial support may be available.

The Zydelig AccessConnect program can also help eligible patients and their providers with the timely delivery of their medications; help navigate insurance requirements for Zydelig coverage, including prior authorization and appeals; and estimate the out-of-pocket costs associated with Medicare Part D.

Zydelig QuickStart Program

The Zydelig QuickStart Program gives eligible patients who have an insurance coverage delay of >5 business days rapid access to a free, 1-time, 30-day supply of Zydelig.

The purchase of Zydelig is not compulsory for participation in the program, but certain restrictions may apply.

Eligibility

Zydelig AccessConnect Copay Coupon Card

To qualify for the Zydelig AccessConnect Copay Coupon Card, patients must:

  • Have a valid prescription for Zydelig
  • Reside in the United States, Puerto Rico, or US territories
  • Not be enrolled in any state-funded or federally funded health insurance programs (eg, Medicaid, Medicare, or Medigap).

The Zydelig AccessConnect Co­pay Coupon Card will cover out-of-pocket costs for Zydelig after the first $5 of each prescription fill, for up to a maximum of 25% of the catalog price of an annual supply of Zydelig.

Zydelig AccessConnect Patient Assistance Program

To qualify for the Zydelig AccessConnect Patient Assistance Program, patients must:

  • Reside in the United States
  • Enroll in Zydelig Access­Connect
  • Receive care from a US physician
  • Have no insurance coverage for the requested medication.

Zydelig QuickStart Program

To qualify for the Zydelig QuickStart Program, patients must meet the following eligibility requirements:

  • A minimum period of 5 business days for insurance verification
  • Having a prescription for Zydelig that is consistent with the FDA-approved label
  • Being enrolled in the Zydelig AccessConnect program.

Patients receiving free drugs under the QuickStart Program may not seek reimbursement or credit for this prescription from any insurer, health plan, or government program.

For patients with a Medicare Part D plan, this prescription, or any cost associated with it, may not be counted as part of their out-of-pocket cost for prescription drugs.

Government Insurance Support

Patients who are enrolled in government health insurance programs may be eligible for assistance from independent foundations. Information and referrals are available online.

Application & Enrollment

Copay Coupon Card

Using the online enrollment form, eligible patients can sign up for the Copay Coupon Card, and print out a copy of their card immediately after. The card is valid for 1 year after the date of receipt or for 15 fills within that 12-month time span.

Patient Assistance Program

For enrollment in this program, the Zydelig AccessConnect form must be completed and faxed to 855-553-8672. For more information about the Patient Assistance Program, call 844-622-2377.

Zydelig QuickStart Program

Patients can enroll in the Zydelig QuickStart Program by filling out section 8 of the Zydelig AccessConnect enrollment form. Section 8 of the enrollment form also includes detailed information about eligibility criteria and what patients can expect to receive with the Zydelig QuickStart Program.

Receiving Zydelig

Zydelig is available to patients only through a limited distribution network, primarily through select specialty pharmacies.

Zydelig AccessConnect can assist practices with identifying the specialty pharmacy associated with the patient’s insurance and forward the prescription to them. Once processed, the medication is mailed directly to the patient’s home, healthcare provider’s office on their behalf, or to in-office pharmacies.

Table Gilead Sciences Oncology Drug

Drug
Indications
Patient support programs

Drug
Zydelig (idelalisib)
Indication
Relapsed chronic lymphocytic leukemia, in combination with rituximab; relapsed follicular B-cell non-Hodgkin lymphoma; relapsed small lymphocytic lymphoma