Verastem Oncology Support Services

Patient Support Services Guide 2019


Verastem Cares
833-570-2273

Verastem Oncology, through its Verastem Cares, offers comprehensive reimbursement and support services for patients who are prescribed Copiktra (duvelisib) capsules and are unable to afford their medication, as well as provider support programs that help them to facilitate patient access to Copiktra and secure patient reimbursements.

Copiktra is a dual kinase inhibitor (PI3K-δ and PI3K-γ inhibitor) that is indicated for the treatment of adults with relapsed or refractory chronic lymphocytic leukemia, small lymphocytic lymphoma, or follicular lymphoma who have not responded to at least 2 previous systemic therapies (Table).

Verastem Cares

Verastem Cares is a comprehensive, personalized program that provides information and assistance via several support services for patients who are prescribed Copiktra, including insurance verification, appeals support, accessing and paying for the medication, and oncology nurse advocate support.

Co-pay/Co-Insurance Assistance

The Verastem Cares Co-pay/Co- Insurance Assistance program helps eligible patients who have commercial insurance to pay as little as $5 per prescription of Copiktra, up to an annual benefit limit of $25,000.

Bridge Rx Program

The Bridge Rx Program helps patients who experience coverage delays or loss of insurance that have lasted longer than 5 days by providing a free 14-day supply of Copiktra until coverage is obtained or until 4 Copiktra shipments have been received.

Patient Assistance Program

The Patient Assistance Program may provide Copiktra free of cost to eligible patients. Patient and provider support services are facilitated by oncology nurse advocates who support patient access to Copiktra via benefit investigations, prior autho­rization, and navigating the appeal process. These advocates also educate patients about taking Copiktra and on treatment adherence, and can assist with the verification of insurance benefits, coverage as­sessments, and prior authorization requirements.

Eligibility

Co-pay/Co-Insurance Assistance

To qualify for the Verastem Cares Co-pay/Co-Insurance Assistance program, patients must:

  • Have commercial insurance
  • Not have Medicare, Medicaid, or other government program ­coverage.

This program has no patient income requirement.

Bridge Rx Program

To qualify for the Bridge Rx Program, patients must:

  • Have coverage delays or loss of insurance lasting longer than 5 days
  • Have been prescribed Copiktra for an on-label indication.

Patient Assistance Program

To qualify for the Patient Assistance Program, patients must:

  • Have annual adjusted gross income that does not exceed $150,000
  • Be a legal US resident, Puerto Rico, or a US ­territory.

Income verification will be based on information provided by the patient, and proof of income may be requested. Financial or insurance information may also be verified with the patient’s employer, healthcare provider, or insurance company.

Application & Enrollment

Providers and patients can enroll in the Verastem Cares program by calling 833-570-2273 or by completing the enrollment form.

To request insurance verification, the Bridge Rx Program, appeals support, copay assistance, and patient or caregiver support services, sections 1 through 6 of the enrollment form must be completed and signed by the physician and by the patient.

To enroll in the Patient Assistance Program, sections 1 through 8 of the enrollment form must be completed.

Completed forms must be faxed to 833-264-8372, with a copy of the front and back of the patient’s insurance card(s).

On submission of the enrollment form to Verastem Cares by the provider, an oncology nurse advocate will confirm receipt with the provider’s office and initiate the requested services.

Table Verastem Oncology Drug

Drug
Indications
Patient support programs

Drug
Copiktra (duvelisib)
Indication
Relapsed or refractory chronic lymphocytic leukemia or small lymphocytic lymphoma after ≥2 previous therapies; relapsed or refractory follicular lymphoma after ≥2 previous systemic therapies