Printed From:

MyPRALUENT® Copay Card

You may qualify for a

$0 Copay

per month for your PRALUENT® (alirocumab) treatment, subject to a maximum annual copay assistance amount of $5,500. Terms and conditions apply.*

 

 

APPLY FOR A COPAY CARD

ACTIVATE YOUR COPAY CARD

LOOK UP A LOST COPAY CARD

If you paid your copay in full for your prescription, download a copay reimbursement form. We may be able to reimburse you, following the terms of the MyPRALUENT® Copay Card Program.

Eligible patients with commercial insurance not funded through a government healthcare program subject to an annual cap and other program terms and restrictions. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs.

Please Complete the form below.

Please complete the form below.

*Required field

The copay card is for U.S. residents only. Unfortunately, you are not eligible for a copay card at this time. If you have any questions, please call 1-844-772-5836.

PRALUENT is an injectable prescription medicine called PCSK9 inhibitor. PRALUENT is used along with diet and the highest tolerated dose of statins in adults with heterozygous familial hypercholesterolemia (an inherited condition that causes high levels of bad cholesterol) or atherosclerotic heart problems, who need additional lowering of bad cholesterol.

Terms and conditions

This program only applies to patients who are at least 18 years of age, residents of the 50 United States, the District of Columbia, and Puerto Rico, are prescribed PRALUENT® (alirocumab) for an FDA-approved indication, and are insured and covered by a commercial health plan. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. It is not an insurance benefit, and does not cover or provide support for supplies, procedures, or any physician-related services associated with PRALUENT. General, non-product specific copay, coinsurance, and deductibles are also not covered. MyPRALUENT® reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms and conditions at any time without notice. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. This offer is not conditioned on any past, present or future purchase, including refills. The copay card is non-transferable, limited to one per person, and cannot be combined with any other offer or discount. This program is not valid where prohibited by law, taxed or restricted. Offer has no cash value. Program is not valid for cash paying customers.

Patient Instructions: PRALUENT must be covered by your commercial insurance. Program is not valid for cash paying customers. If your prescription is covered by insurance, you may need to notify the insurance carrier of redemption of this copay card. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. This program is not valid where prohibited by law. By redeeming this coupon, you are certifying that (1) you are not a beneficiary of any government funded program as noted above; (2) should you begin receiving prescription benefits from any government funded program, you will withdraw from this program; and (3) you acknowledge and understand that adherence to the terms and conditions of this offer is necessary to ensure compliance with laws pertaining to any government funded program. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, please call 1-844-240-3655.

Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state medical pharmaceutical assistance program for this prescription.

Pharmacist Instructions for a Patient with an Eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer coordination of benefits with patient responsibility amount and a valid Other Coverage Code (e.g., 8). Maximum reimbursement limits apply; patient out-of-pocket expense May vary. Reimbursement will be received from CHANGE HEALTHCARE.

For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1-800-422-5604. The card is not transferable and the amount of the rebate cannot exceed the patient’s out-of-pocket expenses. Program managed by ConnectiveRx, on behalf of Sanofi and Regeneron Pharmaceuticals. Product dispensed pursuant to program rules and federal and state laws. The parties reserve the right to amend or end this program at any time without notice.

BY USING THIS COPAY CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Important Safety Information

Do not use PRALUENT if you are allergic to alirocumab or to any of the ingredients in PRALUENT.

Before starting PRALUENT, tell your healthcare provider about all your medical conditions, including allergies, and if you are pregnant or plan to become pregnant or if you are breastfeeding or plan to breastfeed.

Tell your healthcare provider or pharmacist about any prescription and over-the-counter medicines you are taking or plan to take, including natural or herbal remedies.

PRALUENT can cause serious side effects, including allergic reactions that can be severe and require treatment in a hospital. Call your healthcare provider or go to the nearest emergency room right away if you have any symptoms of an allergic reaction, including a severe rash, redness, severe itching, a swollen face, or trouble breathing.

The most common side effects of PRALUENT include: redness, itching, swelling, or pain/tenderness at the injection site, symptoms of the common cold, and flu or flu-like symptoms. Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

Talk to your healthcare provider about the right way to prepare and give yourself a PRALUENT injection and follow the "Instructions for Use" that comes with PRALUENT.

You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

What is PRALUENT® (alirocumab)?

PRALUENT is an injectable prescription medicine called a PCSK9 inhibitor. PRALUENT is used along with diet and maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia (an inherited condition that causes high levels of LDL) or atherosclerotic heart problems, who need additional lowering of LDL cholesterol.

The effect of PRALUENT on heart problems such as heart attacks, stroke, or death is not known.

It is not known if PRALUENT is safe and effective in children.

Click here for Full Prescribing Information for PRALUENT.

Click here to learn more about Sanofi's commitment to fighting counterfeit drugs.

Scroll Up

Important Safety Information

Do not use PRALUENT if you are allergic to alirocumab or to any of the ingredients in PRALUENT.

Before starting PRALUENT, tell your healthcare provider about all your medical conditions, including allergies, and if you
are pregnant or plan to become pregnant or if you are breastfeeding or plan to breastfeed.

+