Patient-Helpdesk.com

cimzia patient assistance form

by Jordyn Willms Published 2 years ago Updated 1 year ago
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How do I request the Cimzia $0 co-pay program?

You must request the CIMZIA $0 Co-Pay Program from your healthcare professional.* If you are eligible for the Program, your doctor’s office will activate your CIMplicity Savings Card (which works as a CIMZIA co-pay card) and keep the information with your patient records in their office. If you self-inject CIMZIA (use the prefilled syringe):

How do I enroll my patients for Cimzia in-office injections?

For dermatologists, please contact your UCB sales representative, Patient Experience Lead (PEL), or call 1-866-4CIMZIA (1-866-424-6942) to receive the Patient Enrollment Form. Have more questions? access and reimbursement. Help other healthcare providers find your practice for their patients who need CIMZIA In-Office Injections.

What is the cimplicity savings program for Cimzia?

CIMplicity offers comprehensive support for your patients, including insurance, co-pay, and nurse support.* for their CIMZIA prescription with the CIMplicity Savings Program. The CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA.

What are the treatment options for Cimzia infection?

Patients who develop a new infection during treatment with CIMZIA should be closely monitored, undergo a prompt and complete diagnostic workup appropriate for immunocompromised patients, and appropriate antimicrobial therapy should be initiated.

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Does CIMZIA have a patient assistance program?

Call ucbCARES™ toll free at 1-844-599-CARE (2273) for more information. The CIMplicity program is provided as a service of UCB, Inc., and is intended to support the appropriate use of CIMZIA. Any CIMplicity program may be amended or canceled at any time without notice.

How do I get CIMZIA for free?

(1-866-424-6942). Eligible patients with a valid prescription for CIMZIA can receive treatment with the CIMZIA Prefilled Syringe at no cost for up to two years or until the patient's coverage is approved, whichever comes first.

How do you get CIMZIA?

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. If you and your doctor have decided that CIMZIA is right for you, simply request a call from a CIMplicity® nurse if you have questions about your treatment including how it works, dosing, and administration. You'll receive a call within the next 15 minutes. Mon.

What is UCB Patient Assistance Program?

Through the UCB Patient Assistance Program, we provide some medications at no cost to eligible and qualified patients who are uninsured or underinsured who otherwise have no access to the UCB medicines prescribed by their physician.

Does CIMZIA cause fatigue?

Tiredness. If you feel more tired than usual, it may be a side effect of Cimzia. But tiredness may also be a symptom of infection. And Cimzia has a warning about the risk of infection while using the drug.

Do CIMZIA injections hurt?

“I've been on Cimzia for about a year with good but not great success. The injections are very painful.

Are cimzia injections covered by Medicare?

CIMZIA* is now covered by Medicare Administrative Contractors administering Medicare Part B to patients in all 50 United States and US Territories.

How long does it take to get Cimzia out of your system?

Because the elimination of certolizumab pegol may take up to 5 months, monitoring should be continued throughout this period (see section 4.3).

How long does it take for Cimzia to take effect?

Cimzia injection can work as fast as 1 or 2 weeks in some people for conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. Its full effectiveness can range from 4 months to 1 year based on your specific medical condition.

What does UCB stand for pharma?

Union Chimique BelgeUCB (Union Chimique Belge) is a multinational biopharmaceutical company headquartered in Brussels, Belgium.

Who makes Keppra?

The branded version Keppra is manufactured by UCB Pharmaceuticals Inc.

Is CIMZIA covered by Medicare Part B?

CIMZIA* is now covered by Medicare Administrative Contractors administering Medicare Part B to patients in all 50 United States and US Territories.

Does Medicare B pay for CIMZIA?

If you have coverage through traditional Medicare Part B, after you satisfy your deductible, Medicare covers 80% of the drug cost, and you pay the remaining 20% coinsurance. Supplemental Medicare insurance plans may also cover this 20% depending on your plan.

How long does it take for CIMZIA to work?

Cimzia injection can work as fast as 1 or 2 weeks in some people for conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and non-radiographic axial spondyloarthritis. Its full effectiveness can range from 4 months to 1 year based on your specific medical condition.

How often do you take CIMZIA?

The recommended initial adult dose of CIMZIA is 400 mg (given as two subcutaneous injections of 200 mg) initially, and at Weeks 2 and 4. In patients who obtain a clinical response, the recommended maintenance regimen is 400 mg every four weeks.

What is CIMZIA used for?

CIMZIA is indicated for reducing signs and symptoms of Crohn's disease (CD) and maintaining clinical response in adult patients with moderately to severely active disease who have had an inadequate response to conventional therapy

What are the side effects of CIMZIA?

Angioedema, anaphylaxis, dyspnea, hypotension, rash, serum sickness, and urticaria have been reported following CIMZIA administration. If a serious allergic reaction occurs, stop CIMZIA and institute appropriate therapy. The needle shield inside the removable cap of the CIMZIA prefilled syringe contains a derivative of natural rubber latex which may cause an allergic reaction in individuals sensitive to latex.

What is the TNF blocker?

TNF blockers, including CIMZIA, have been associated with rare cases of new onset or exacerbation of central nervous system and peripheral demyelinating diseases , including multiple sclerosis, seizure disorder, optic neuritis, peripheral neuropathy, and Guillain-Barré syndrome.

How to get a patient enrollment form for UCB?

Reach out to your UCB sales representative, or call 1-866-4-CIMZIA (1-866-424-6942), to get a Patient Enrollment Form for your patients.

Is Cimzia contraindicated?

CIMZIA is contraindicated in patients with a history of hypersensitivity reaction to certolizumab pegol or to any of the excipients. Reactions have included angioedema, anaphylaxis, serum sickness, and urticaria.

How to contact CIMplicity?

For support with access and reimbursement, call CIMplicity at. 1-866-4-CIMZIA (1-866-424-6942). Eligibility and restrictions. CIMplicity Savings Program. Available to individuals with commercial prescription insurance coverage for a valid prescription of an FDA-approved indication for CIMZIA.

What is a dedicated nurse?

Dedicated nurses provide patients with services that reinforce the education and treatment plan provided by their doctor.

How to get a free sharps disposal container?

To get a free sharps disposal container delivered to your home for proper storage and disposal of your used CIMZIA prefilled syringes, sign up for the CIMplicity program or call 1-844-UCBNurse (1-844-822-6877).

How much is CIMZIA out of pocket?

For eligible commercially insured patients, CIMZIA is available for $0 out-of-pocket with the CIMplicity Savings Program.† We are committed to helping you save on your cost of treatment with CIMZIA.

What is cimplicity for cimzia?

CIMplicity® is available to help you with your CIMZIA treatment. While you are enrolled in the program, you will be provided with tools and support to help empower you to manage your condition.*

How to change reminders for CIMZIA?

If you ever need to change your reminder selections, just log in to your CIMplic ity account to make updates.

What is the maximum amount of Medicare benefits?

The maximum annual benefit amount is $15,000 per calendar year. The parties reserve the right to amend or end this program at any time without notice.

Does UCB send syringes?

members of your community. the environment. UCB will send you everything you need, including a syringe disposal container, a box to return it with prepaid postage, and instructions to mail it back for safe disposal once it's full.

Can UCB be liable for lost or stolen CIMplicity card?

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. UCB, Inc., is not liable for unintended or unauthorized use of the CIMplicity Savings Card if it is lost or stolen.

What is Medicare Part D?

Medicare Part D: A program that helps pay for prescription drugs for people with Medicare. Medigap: Extra health insurance you can buy from a private company to pay healthcare costs not covered by original Medicare (for example, co-pays, deductibles, and healthcare if you travel outside the United States).

What is Medicare for people over 65?

Medicare is a federally funded health insurance program for: People age 65 or older. People younger than 65 with certain disabilities. People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)

What is coinsurance in healthcare?

Coinsurance: Your share of the cost of a covered healthcare service, usually a percentage of the allowed amount for the service (for example, 10%). You pay coinsurance after you’ve met your deductible.

What is benefits investigation?

Benefits investigation: An analysis, usually done by a doctor’s office, to see if a service or prescription is covered under your insurance plan (also known as benefits verification).

What does "out of network" mean?

Out of network: Healthcare services received by providers not contracted with your insurance plan.

What is exchange plan?

Exchange plan: The insurance you set up through the Healthcare Insurance Marketplace.

What is the exchange for health insurance?

Programs and costs vary, especially in terms of coverage, co-pays, and deductibles. About the Health Insurance Marketplace (the Exchange) The Health Insurance Marketplace, also known as the Exchange, was created through the Affordable Care Act (ACA), commonly called Obamacare. The Exchange is your state’s price comparison website ...

What is CIMZIA used for?

CIMZIA is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker used in adults to: Lessen the signs and symptoms of moderately to severely active Crohn’s disease (CD) in adults who have not been helped enough by usual treatments.

How long does it take to get a call from a CIMZIA nurse?

You'll receive a call within the next 15 minutes.*

What is the name of the medicine that is used to treat a swollen ear?

use the medicine Kineret ® (anakinra), Orencia ® (abatacept), Rituxan ® (rituximab), or Tysabri ® (natalizumab)

What are the symptoms of TB?

Before starting CIMZIA, tell your healthcare provider if you: think you have an infection or have symptoms of an infection such as: fever, sweat, or chills. muscle aches. cough.

What are the conditions that affect the nervous system?

have or have had lymphoma or any other type of cancer. have or had congestive heart failure. have or have had seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis or Guillain-Barre syndrome. are scheduled to receive a vaccine.

Can you take Cimzia while pregnant?

You and your doctor should decide if you should continue to take CIMZIA while you are pregnant. It is not known if CIMZIA will harm your unborn baby. Pregnancy Registry: If you become pregnant during treatment with CIMZIA, talk to your healthcare provider about registering in the pregnancy exposure registry for CIMZIA.

How to report side effects of prescription drugs?

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

How to activate CIMZIA card?

If you are eligible for the CIMplicity Savings Program, as soon as you receive your card, call the number on the card to activate it so you can start saving on the cost of CIMZIA treatment. When your pharmacy calls, simply give the 10-digit number on the card as method of payment. It is that simple!

What is the phone number for a CIMplicity card?

If the pharmacy approved by your insurance company does not accept or is unable to process your CIMplicity Savings Card, call 1-844-277-6853.

What is the phone number for UCB?

If you do not have insurance, UCB’s Patient Assistance Program may be able to help. Call 1-866-395-8366 to learn more.

Does CIMZIA have a copay?

You must request the CIMZIA $0 Co-Pay Program from your healthcare professional.* If you are eligible for the Program, your doctor’s office will activate your CIMplicity Savings Card (which works as a CIMZIA co-pay card) and keep the information with your patient records in their office.

Can you cancel cimplicity?

Any CIMplicity program may be amended or canceled at any time without notice. Some program and eligibility restrictions apply. Please consult your doctor if you have any questions about your condition or treatment. You are encouraged to report negative side effects of prescription drugs to the FDA.

What is CIMZIA used for?

CIMZIA is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker. CIMZIA is used in adult patients to: •essen the signs and symptoms of moderately to severely active Crohn’s disease (CD) in patients who L have not been helped enough by usual treatments. •reat moderately to severely active rheumatoid arthritis (RA). T •reat active psoriatic arthritis (PsA). T •reat active ankylosing spondylitis (AS) T

What are the adverse events of CIMZIA?

In controlled Crohn’s clinical trials, the most common adverse events that occurred in ≥5% of CIMZIA patients (n=620) and more frequently than with placebo (n=614) were upper respiratory infection (20% CIMZIA, 13% placebo), urinary tract infection (7% CIMZIA, 6% placebo), and arthralgia (6% CIMZIA, 4% placebo). The proportion of patients who discontinued treatment due to adverse reactions in the controlled clinical studies was 8% for CIMZIA and 7% for placebo. In controlled RA clinical trials, the most common adverse events that occurred in ≥3% of patients taking CIMZIA 200 mg every other week with concomitant methotrexate (n=640) and more frequently than with placebo with concomitant methotrexate (n=324) were upper respiratory tract infection (6% CIMZIA, 2% placebo), headache (5% CIMZIA, 4% placebo), hypertension (5% CIMZIA, 2% placebo), nasopharyngitis (5% CIMZIA, 1% placebo), back pain (4% CIMZIA, 1% placebo), pyrexia (3% CIMZIA, 2% placebo), pharyngitis (3% CIMZIA, 1% placebo), rash (3% CIMZIA, 1% placebo), acute bronchitis (3% CIMZIA, 1% placebo), fatigue (3% CIMZIA, 2% placebo). Hypertensive adverse reactions were observed more frequently in patients receiving CIMZIA than in controls. These adverse reactions occurred more frequently among patients with a baseline history of hypertension and among patients receiving concomitant corticosteroids and non-steroidal anti-inflammatory drugs. Patients receiving CIMZIA 400 mg as monotherapy every 4 weeks in RA controlled clinical trials had similar adverse reactions to those patients receiving CIMZIA 200 mg every other week. The proportion of patients who discontinued treatment due to adverse reactions in the controlled clinical studies was 5% for CIMZIA and 2.5% for placebo. The safety profile for patients with Psoriatic Arthritis (PsA) treated with CIMZIA was similar to the safety profile seen in patients with RA and previous experience with CIMZIA. The safety profile for AS patients treated with CIMZIA was similar to the safety profile seen in patients with RA.

What happens if you get a CIMZIA?

After starting CIMZIA,if you get an infection, any sign of an infection including a fever, cough, flu-like symptoms, or have open cuts or sores on your body, call your healthcare provider right away. CIMZIA can make you more likely to get infections or make any infection that you may have worse.

What is the risk of CIMZIA?

Risk of Serious Infections and Malignancy Patients treated with CIMZIA are at an increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.

How to fax CIMplicity enrollment form?

CIMplicity Enrollment and Benefits Investigation Form Complete and fax to 1-866-949-2469 By fi lling out this form, your patient will be enrolled in the CIMplicity program.

What medicine should I take for a high chance of infection?

Especially tell your healthcare provider if you take the following medicines due to a higher chance for serious infections: • ®Kineret (anakinra), Orencia®(abatacept), Rituxan®(rituximab), or Tysabri®(natalizumab) •dici nes called Tumor Necrosis Factor (TNF) blockers, such as Remicade ®me (infliximab), Humira®.

What age can you take immunosuppressants?

Patients greater than 65 years of age, patients with co-morbid conditions, and/or patients taking concomitant immunosuppressants (e.g., corticosteroids or methotrexate) may be at a greater risk of infection.

UCB Financial Assistance During COVID-19 Pandemic

We understand some patients are facing hardship due to the COVID-19 pandemic and may experience difficulty affording UCB medicines due to job loss, job furlough, or loss of insurance coverage.

Information for Veterans

If you served in the active military, naval, or air service and were honorably discharged, you may be eligible for VA health care benefits. For more information: https://www.va.gov/health-care/eligibility/

UCB Prescription Co-Pay Assistance Programs

If you have been prescribed BRIVIACT ® (brivaracetam) CV, CIMZIA ® (certolizumab pegol), NAYZILAM ® (midazolam) nasal spray CIV, NEUPRO ® (rotigotine transdermal system), or VIMPAT ® (lacosamide) CV and would like to apply for a co-pay assistance card, please click on the appropriate link above.

UCB Patient Assistance Program (PAP)

If you need any financial assistance, you may qualify for the UCB Patient Assistance Program (PAP). You can access the online application here.

Understanding your Insurance

Choosing the right insurance plan for you and your family can be confusing. We’ve developed a guide to help you navigate the process.

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