GILOTRIF Patient Services. Learn how the GILOTRIF Patient Services program can help your patients navigate their journey on GILOTRIF
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1 GILOTRIF Patient Services Learn how the GILOTRIF Patient Services program can help your patients navigate their journey on GILOTRIF
2 Helpful information about access and clinical support Prescribing GILOTRIF Follow these steps to prescribe GILOTRIF for your patients: 1 2 Get a GILOTRIF prescription form Complete the GILOTRIF prescription form* Contact your sales consultant Download at GilotrifHCP.com Contact Accredo at Fax the form to Accredo at * Some states may require a separate prescription. Support for patients right from the start Along with their first month s supply of GILOTRIF, patients will receive: My Guide: Information about taking GILOTRIF Supportive care products My Support Kits are available in English, Spanish, Vietnamese, Chinese, and Korean 3 Once GILOTRIF prescription enrollment is complete Your patients will receive a welcome call, confirming enrollment and insurance benefits The first delivery often arrives within 4 days Upon receiving the prescription and enrollment form, Accredo will fill the prescription and call your patients to schedule their GILOTRIF delivery
3 Offers patients both access and clinical support GILOTRIF access and support for patients Coverage and access assistance Patient Specialists investigate and verify coverage for your patients within 2 business days Patient Specialists communicate prior authorization requirements for payers and assist with the reimbursement process Co-pay Assistance Program* Ensures maximum out-of-pocket cost is no more than $25 per month for commercially insured US-resident patients No income eligibility, benefit cap, or additional paperwork GILOTRIF Dose Exchange Facilitates transition to a new dose at no cost to your patients* Eliminates additional GILOTRIF co-pay in a given month for eligible patients Eligible patients receive a new dose of GILOTRIF Convenient packaging to return unused tablets Call to learn more *Co-pay assistance program is available to commercially insured patients. GILOTRIF Dose Exchange covers up to 2 dose modifications for patients serviced through Accredo or GILOTRIF Dispensing Network who have 9 or more tablets to exchange. Alternative funding support Patient Specialists will direct patients to nonprofit independent foundations, including the Boehringer Ingelheim Cares Foundation Patient Assistance Program Bridge Program Eligible patients experiencing more than a 5-day payer approval delay can receive a 15-day supply of GILOTRIF at no cost to the patient for the FDA-approved indication We ensure maximum monthly out-of-pocket cost is no more than $25 for commercially insured patients.
4 Offered by Accredo The following Nurse and Pharmacy services are available for your patients Your Patients Roadmap Patients will receive a welcome call, program overview, and GILOTRIF delivery schedule starting on Day 1. Nurses will continue to reach out to patients to help enhance patient adherence as needed. Day 1: Initial Patient Counseling With Patient Care Advocate/Nurse Day 5: Pharmacist Outreach Day 10: Pharmacist Follow-up Day 21: Day 45: As Needed Patients can reach an Accredo representative Monday-Friday from 8am to 8pm by calling Communication with patients may vary based on individual patient need and availability.
5 Prescribing GILOTRIF Follow these steps to prescribe GILOTRIF for your patients: 1 Get a GILOTRIF prescription form 2 3 Complete the GILOTRIF prescription form* Once GILOTRIF prescription enrollment is complete Contact your sales consultant Download at GilotrifHCP.com Contact Accredo at Fax the form to Accredo at * Some states may require a separate prescription. Your patients will receive a welcome call, confirming enrollment and insurance benefits For any questions or assistance please contact your GILOTRIF sales consultant or call to speak with the dedicated GILOTRIF Accredo team Copyright 2017 Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved. Printed in the U.S.A. (9/17) PC-US
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