FAQ’s

Answers to some frequently asked questions about Thyrogen Coverage

Reimbursement FAQ’s

Your insurance plan will determine if Thyrogen is covered by major medical or pharmacy benefit or both. You may obtain this information from your insurance plan . You may also call 1-88-THYROGEN to speak with a dedicated Case Manager.

Call your insurance company to determine your co-pay or OOP expense for Thyrogen. In addition, you may call 1-88-THYROGEN (1-888-497-6436) to determine if you are eligible for the Thyrogen Co-Pay Assistance Program. If you are, you will receive the Thyrogen Co-Pay Card in the mail, which will cover up to $1,000 of your out of pocket (OOP) expenses. Call your insurance company to determine if you have additional OOP above the $1,000 co-pay assistance. If you do, your insurance company will tell you how much it is.


IMPORTANT NOTICE: The Co-Pay Program does not cover prescriptions eligible to be reimbursed, in whole or in part, by a state or federal health care program, including but not limited to Medicare, Medicare Advantage Plans (Example: FreedomBlue offered through BlueCross Blue Shield), Medicare Part D, Medicaid, Medigap, Veterans Affairs, Department of Defense, or TRICARE. In accordance with State law, the Program does not reimburse infusion-related charges for commercially insured patients residing in Massachusetts, Michigan, or Rhode Island. (Charitable Access Program patients residing in these states are eligible to receive assistance for infusion-related charges while they are receiving charitable drug.) No claim for reimbursement of any out-of-pocket expenses covered by the Co-Pay Program may be submitted to any third-party payer, whether public or private. The Co-Pay Program is available only in the United States and cannot be combined with any other rebate/coupon, free trial, or similar offer. Co-Pay benefits are not transferable. Sanofi Genzyme reserves the right to rescind, revoke, modify, or amend this program without notice. Through your participation in the Co-Pay Program, you understand and agree to comply with the terms and conditions set forth above.

Thyrogen is generally covered by Medicare Part B when it is medically necessary and administered in the outpatient or doctor's office setting as part of a physician’s service.

Medicaid eligibility and benefit plans vary from state-to-state. Your local state’s program’s coverage policy should be understood before treatment is initiated. Usually, use of Thyrogen will need to be considered medically necessary to be covered under the Medicaid program. Depending on the state, use of Thyrogen may require prior approval request by the state Medicaid program. If this is the case, your doctor can fill out a prior authorization form stating your medical necessity. If the state Medicaid office approves the request, you will be eligible to receive Thyrogen

Resources

Thyrogen Co-Pay Self Application Form

{ Please complete this form to apply for Thyrogen Co-Pay Assistance }

Thyrogen Patient Assistance Program Application Form

{ If you have no insurance or insufficient insurance, ask your doctor to fill out this form }