IPSEN CARES: Coverage, Access, Reimbursement & Education Support
Ipsen Biopharmaceuticals provides several patient support services through its IPSEN CARES (Coverage, Access, Reimbursement, & Education Support) program to patients who are prescribed Onivyde (irinotecan liposome injection) or Soma-tuline Depot (lanreotide) injection.
Somatuline Depot, a somatostatin analog, is indicated for adults with carcinoid syndrome and for patients with unresectable, well-differentiated or moderately differentiated, locally advanced or metastatic gastroenteropancreatic neuroendocrine tumors.
Onivyde, a topoisomerase inhibitor, is indicated, in combination with fluorouracil and leucovorin, for the treatment of patients with metastatic adenocarcinoma of the pancreas that progressed after gemcitabine-based therapy (Table).
IPSEN CARES Support Services
IPSEN CARES facilitates access to Onivyde and Somatuline Depot for patients who are insured, underinsured, or uninsured through its various services. These services include:
Assisting in insurance verification, determination of out-of-pocket costs, prior authorization, and claims appeals.
Providing copay assistance for eligible patients through the Somatuline Depot Copay Program, Onivyde Copay Program, and the Somatuline Depot Virtual Copay Savings Program.
Referral to independent nonprofit organizations for patients who have government-provided insurance, and coordinating the delivery of specialty pharmacy networks based on insurance requirements and triage referrals.
Providing free medication to eligible uninsured patients through the Somatuline Depot or the Onivyde Patient Assistance Program to avoid treatment delays or interruptions.
Onivyde Copay Program
Eligible patients enrolled in this program may receive up to an annual copay assistance of $20,000, with most patients being responsible for $0 of Onivyde prescription. Eligible patients must:
- Be receiving treatment with Onivyde
- Have commercial insurance and not be considered cash-pay patients (ie, patients without insurance coverage or those who have commercial insurance that does not cover Onivyde)
- Not be enrolled in a federal- or state-subsidized healthcare program that covers prescription drugs, including Medicare (such as Medicare Part D), Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs.
Somatuline Depot Copay Program
Depending on whether the patient requires the pharmacy or medical benefit, 2 types of copay programs are currently offered to eligible, commercially insured patients who are prescribed Somatuline Depot to reduce their out-of-pocket costs: the Copay Program for the pharmacy benefit and the Virtual Copay Savings Program for the medical benefit.
Eligible patients enrolled in the 2 programs may receive an annual benefit of up to $20,000, with most patients being responsible for $5 of each prescription. Both programs are available to all eligible patients, but a patient can only participate in 1 program at a time. Patients may switch programs if their benefit needs change, but they are subject to an aggregate annual maximum savings of $20,000.
To be eligible for these programs, patients must:
- Be receiving treatment with Somatuline Depot
- Have commercial insurance that covers Somatuline Depot and its associated cost, or be uninsured and pay their entire cost out of pocket
- Not be enrolled in a federal- or a state-subsidized healthcare program that covers prescription drugs, including Medicare (such as Medicare Part D), Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs.
Onivyde/Somatuline Depot Patient Assistance Program
To be eligible for this program, patients must:
- Have no insurance coverage
- Be US residents
- Be prescribed and administered Somatuline Depot or Onivyde
- Meet specific income criteria.
Application & Enrollment
To be eligible for the patient support programs for Onivyde or for Somatuline Depot, patients must be enrolled in IPSEN CARES. Enrollment may be initiated by calling 866-435-5677, or through the online provider portal. Alternatively, the IPSEN CARES Enrollment Form (available at IPSENCARES.com) may be downloaded, completed, and faxed to 888-525-2416. The Patient Authorization form must be completed every 12 months to give IPSEN CARES permission to access the patient’s personal health information.
Somatuline Depot Copay Program
IPSEN CARES will evaluate the patient eligibility by conducting a benefits verification and will determine whether the patient qualifies for the Copay Program, the Virtual Copay Savings Program debit card, or the Patient Assistance Program. A copay card is issued if the patient qualifies for the pharmacy benefit, and the patient is enrolled in the virtual debit card program if he or she qualifies for the medical benefit.
To receive savings through the Virtual Copay Savings Program, the prescriber must prescribe Somatuline Depot for the patient, collect the patient’s copay, and submit a claim to the patient’s insurance company for the copay. The explanation of benefits (EOB) statement from the insurance company must be sent to IPSEN CARES for processing by mail, or by fax to 888-525-2416. An IPSEN CARES program coordinator will review the EOB and will fax a virtual debit card to the physician’s office or practice, which the physician can use toward the patient’s medication. The card is valid for 30 days, and a new card will be issued for the next successful EOB.
Patient Assistance Program
For enrollment in the Somatuline Depot or Onivyde Patient Assistance Program, Ipsen’s Patient Financial Support Application must be completed by the patient and the prescriber, and faxed to 888-525-2416.
Proof of total household income, such as a recently filed federal tax form, including supporting documents, must be submitted. The healthcare provider will be notified on completion of the eligibility review.