This website is intended for US residents only
Ipsen recognizes more work is now being done by computer rather than by paper and fax machines. We hope this online portal will be a convenient resource for you and your office.
After you register and create a profile, your profile will be validated within 1 business day.
We are collecting personal information in order to fulfill your request. Please see Ipsen’s privacy policy at https://www.ipsen.com/us/privacy-policy/
*Patient Eligibility & Terms and Conditions: Only patients with commercial insurance and “cash-pay” patients are eligible. “Cash-pay” patients are defined for purposes of this program as patients without insurance coverage or who have commercial insurance that does not cover the Ipsen product in question. 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®. Patients are not eligible if prescriptions are paid in part or full by any state or federally funded programs, 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 who begin receiving prescription drug benefits from Government Programs at any time will no longer be eligible for copay assistance. Patients whose insurance plan is paying the entire cost of the prescriptions are not eligible. 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.
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 RX Crossroads 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. Please see individual program information for program-specific patient eligibility and terms and conditions.