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IPSEN CARES Enrollment Form
Nurse Home Health Administration (NHHA) is available for patients who have difficulty receiving their Somatuline Depot injections at their doctor’s office. Eligible* patients can have an IPSEN CARES® nurse visit their home or work to administer their injections. There is no cost to the patient for this option. NHHA must be requested by the doctor and the patient must be enrolled in IPSEN CARES.
- During the COVID-19 pandemic, IPSEN CARES is temporarily expanding eligibility for Nurse Home Health Administration services. Please contact IPSEN CARES for details.
*Patient Eligibility for Nurse Home Healthcare Administration: A physician must prescribe Somatuline Depot to be administered by Home Health Administration for the patient. The program is available to most patients covered by commercial insurance plans. Patients are not eligible if prescriptions are paid in part or fully by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, VA, DoD or TRICARE. Residents of Massachusetts, Michigan, Minnesota, and Rhode Island are not eligible.
Uninsured patients may be eligible for free medication through our Patient Assistance Program. Patients may be eligible to receive free drug if they are experiencing financial hardship, have no insurance coverage, and received a prescription for an on-label use of Somatuline Depot, as supported by information provided in the program application. Patients may enroll through IPSEN CARES®. If eligible, they may receive free medication from Ipsen.
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Patients/caregivers are required to sign the Somatuline Depot Patient Authorization form every 3 years or sooner if required by state law to give the Patient Access Specialists at IPSEN CARES® permission to access the patient’s personal health information in order to help with treatment. The form can be signed and submitted online, or by downloadable PDF, which must be printed, filled out, signed, and faxed.
Check for copay coverage. Considering that some patients need financial assistance, our copay assistance programs may help eligible* patients with the cost of their treatment.
The Somatuline Depot Copay Program for eligible, commercially insured and uninsured patients is available by enrolling in IPSEN CARES®. Here is the key information:
- Patients may pay as little as $0 for their Somatuline Depot injection
- For patients utilizing the Pharmacy Benefit, we will provide the virtual pharmacy copay card information on behalf of the patient directly to the specialty pharmacy being utilized
- For patients utilizing the Medical Benefit, we will send details for claims processing on behalf of the patient directly to the doctor’s office
- For patients who are eligible for government health benefits (eg, Medicare, Medicaid, TRICARE), IPSEN CARES may be able to offer the contact information for independent nonprofit foundations that may be able to offer financial assistance
IPSEN CARES
Copay Assistance Flashcard
IPSEN CARES Patient
Copay Flashcard
*Patient Eligibility & Terms and Conditions: Patients are not eligible for copay assistance through IPSEN CARES® if they are enrolled in any state or federally funded programs for which drug prescriptions or coverage could be paid in part or in full, including, but not limited to, Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE (collectively, “Government Programs”), or where prohibited by law. Patients residing in Massachusetts, Minnesota, Michigan, or Rhode Island can only receive assistance with the cost of Ipsen products but not the cost of related medical services (injection). Patients receiving assistance through another assistance program or foundation, free trial, or other similar offer or program, are not eligible for the copay assistance program during the current enrollment year.
Cash-pay patients are eligible to participate. “Cash-pay” patients are defined for purposes of this program as patients without insurance coverage or who have commercial insurance that does not cover Somatuline® Depot. Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not considered cash-pay patients and are not eligible for copay assistance through IPSEN CARES®. For patients with commercial insurance who are not considered to be cash-pay patients, the maximum copay benefit amount per prescription is an amount equal to the difference between the annual maximum copay benefit of $20,000 and the total amount of copay benefit provided to the patient in the Somatuline® Depot Copay Program. For cash-pay patients, the maximum copay benefit amount per prescription is $1,666.66, subject to the annual maximum of $20,000 in total. Patient pays any amount greater than the maximum copay savings amount per prescription.
Patient or guardian is responsible for reporting receipt of copay savings benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled through the program, as may be required. Additionally, patients may not submit any benefit provided by this program for reimbursement through a Flexible Spending Account, Health Savings Account, or Health Reimbursement Account. Ipsen reserves the right to rescind, revoke, or amend these offers without notice at any time. Ipsen and/or RxCrossroads by McKesson, are not responsible for any transactions processed under this program where Medicaid, Medicare, or Medigap payment in part or full has been applied. Data related to patient participation may be collected, analyzed, and shared with Ipsen for market research and other purposes related to assessing the program. Data shared with Ipsen will be de-identified, meaning it will not identify the patient. Void outside of the United States and its territories or where prohibited by law, taxed, or restricted. This program is not health insurance. No other purchase is necessary.
Nurse Home Health Administration (NHHA) is available for patients who have difficulty receiving their Somatuline Depot injections at their doctor’s office. Eligible* patients can have an IPSEN CARES® nurse visit their home or work to administer their injections. There is no cost to the patient for this option. NHHA must be requested by the doctor and the patient must be enrolled in IPSEN CARES.
- During the COVID-19 pandemic, IPSEN CARES is temporarily expanding eligibility for Nurse Home Health Administration services. Please contact IPSEN CARES for details.
*Patient Eligibility for Nurse Home Healthcare Administration: A physician must prescribe Somatuline Depot to be administered by Home Health Administration for the patient. The program is available to most patients covered by commercial insurance plans. Patients are not eligible if prescriptions are paid in part or fully by any state or federally funded programs, including, but not limited to, Medicare or Medicaid, VA, DoD or TRICARE. Residents of Massachusetts, Michigan, Minnesota, and Rhode Island are not eligible.
Uninsured patients may be eligible for free medication through our Patient Assistance Program. Patients may be eligible to receive free drug if they are experiencing financial hardship, have no insurance coverage, and received a prescription for an on-label use of Somatuline Depot, as supported by information provided in the program application. Patients may enroll through IPSEN CARES®. If eligible, they may receive free medication from Ipsen.