QUESTIONS ABOUT
INSURANCE CHANGES?
Changes in coverage or loss of insurance? We can help. Here’s what to do to avoid a disruption in your treatment.
If your insurance plan has changed their coverage of COSENTYX® (secukinumab), it may be due to a change to their prescription drug formulary list. Most insurance plans have a list of preferred and covered medications called a formulary. This list may be re-evaluated every year based on a number of factors, including cost, safety, and effectiveness of the medication. In some instances, the insurance plan might remove COSENTYX from their formulary and exclude it from coverage, which may force a non-medical change to another medication. A change to your medication for a non-medical reason, may be challenging. If it’s important to you to stay on COSENTYX, a medication you and your doctor decided is the best choice for you, here are steps you can take.
If your insurance coverage has changed:
Call your insurance company and tell them you want to stay on COSENTYX. Ask for information about filing a medical exception and how soon this can be submitted so your COSENTYX coverage doesn’t end. A medical exception can be based on:
Any prior medications you have taken for your condition
How long you have been on COSENTYX
Satisfaction with your results
Tell your doctor that you want to stay on COSENTYX and ask your doctor to submit a medical exception to your insurance plan. You can help your doctor by providing the date your insurance plan will be ready to accept your medical exception submission.
To help ensure that you don’t miss a dose of COSENTYX due to this change, your doctor may be able to write a prescription for a 90-day supply of COSENTYX. If this is not possible, your doctor may be able to help you with other options to stay on COSENTYX.
Novartis Patient Assistance Foundation
The Novartis Patient Assistance Foundation, Inc. (NPAF), a non-profit organization, is committed to providing access to Novartis medications for those most in need. If you are experiencing financial hardship, have limited or no prescription coverage, and cannot afford the cost of your medication, then you may be eligible to receive Novartis medications for free. To learn more, call 1-800-277-2254 or visit www.PAP.Novartis.com.
"My doctor said that my insurance was tough, but that COSENTYX® Connect would help me understand my options, and they did. COSENTYX works for me. Four years and counting."
Individual results may vary. Dewey was compensated for his time.
Frequently Asked Questions About Insurance Changes
Get answers to frequently asked questions about insurance changes below or call COSENTYX® Connect at 1-844-267-3689.
Co-Pay Plus Terms & Conditions
*Offer valid only when used with commercial health insurance. Offer is not available where:
the patient has federal or state health plan benefits (eg, Medicare, Medicaid, TRICARE, VA);
the health plan reimburses for the entire cost of the drug;
the health plan provides no coverage for the drug; or
prohibited by law.
The amount of funding available from the Program is subject to an annual limit. Novartis reserves the right to discontinue the availability of co-pay assistance if, at any time, Novartis determines that the patient is subject to a co-pay maximizer program. Co-pay maximizers are programs implemented by health plans in which the amount of the patient’s out-of-pocket cost is increased to reflect the availability of support offered by a manufacturer assistance program. The patient is responsible for all costs once available funding from the Program is exhausted.
The Program is designed exclusively for the benefit of the patient. The amount of available funding may be reduced or eliminated if it is not credited by the patient’s health plan toward the patient’s out-of-pocket obligations (eg, deductibles, annual out-of-pocket maximums). Program funding may also be reduced or eliminated if the patient’s health plan, directly or indirectly, adjusts, reduces, or waives the patient’s health plan benefits based on the availability of, or the patient’s enrollment in, the Program, or otherwise acts in a manner that materially affects these Terms and Conditions.
Only the patient or their legal guardian or caregiver may enroll the patient in the Program. Health plans, specialty pharmacies, pharmacy benefit managers, and their agents and representatives (individually and collectively “Plan Administrators”), are prohibited from enrolling patients in the Program.
Patients in the Program are responsible for notifying Novartis of any change in their prescription drug health plan coverage that may conflict or otherwise affect compliance with these Terms and Conditions. By accepting Program funding from Novartis on behalf of participating patients, Plan Administrators agree to not take any action that materially affects compliance with these Terms and Conditions.
Patients may not seek reimbursement for the value received from the Program from any other party (eg, health plans, flexible spending or healthcare savings accounts). Patients are responsible for complying with any applicable limitations and requirements of their health plan related to their use of the Program.
Valid only in the United States and Puerto Rico. Co-pay support for infusion administration cost not available in Rhode Island or Massachusetts.
The Program is not health insurance, and may not be combined with any third-party rebate, coupon, or offer. Novartis reserves the right to rescind, revoke, or amend the Program at any time without notice.
†The Covered Until You're Covered Program is available for COSENTYX subcutaneous injection only. Eligible patients must have private insurance, a valid prescription for COSENTYX, and a denial of insurance coverage based on a prior authorization request. Program requires the submission of an appeal of the coverage denial within the first 90 days of enrollment in order to remain eligible. Program provides COSENTYX for free to eligible patients for up to two years, or until they receive insurance coverage approval, whichever occurs earlier. A valid prescription consistent with FDA-approved labeling is required. Program is not available to patients whose medications are reimbursed in whole or in part by Medicare, Medicaid, TRICARE, or any other federal or state program. Patients may be asked to reverify insurance coverage status during the course of the program. No purchase necessary. Program is not health insurance, nor is participation a guarantee of insurance coverage. Limitations may apply. Enrolled patients awaiting coverage for COSENTYX after two years may be eligible for a limited Program extension. Novartis Pharmaceuticals Corporation reserves the right to rescind, revoke, or amend this Program without notice.