KevzaraConnect®

Ensure your patients get the support they need with the Patient Assistance Program and $0 copay for those eligible.

KEVZARA SAMPLE PROGRAM


Visit our sample portal for the following convenient services:

  • Order samples remotely once validated and through a few clicks—no phone calls, no emails, no texts
  • Choose among KEVZARA 200 mg or 150 mg pre-filled pen
  • Close any outstanding Acknowledgement of Product (AOP) requirements by acknowledging receipt electronically

To register, simply click on the link below and provide your name, email, zip code, and HCP identifier (NPI, ME, or SLN). Your application will then be reviewed and, if approved, your account/email will then be validated and made active.

Request Samples

KEVZARA EXPERIENCE VOUCHER PROGRAM

TO ORDER A FREE, ONE-TIME, 30-DAY SUPPLY FOR YOUR PATIENT

1

Download and complete the information on the voucher form below.

This free trial will be supplied through TheraCom. Vouchers and samples cannot be combined, and the voucher is not intended to address insurance delays and gaps in coverage. See terms and conditions on the form below.

2

Fax the completed voucher and a written 30-day prescription for KEVZARA to:

TheraCom Pharmacy
345 International Blvd, Ste 200
Brooks, KY 40109
Fax 888-261-4939 or
call 855-417-7859

3

Inform the patient to expect a call from TheraCom within 2 business days to schedule delivery for a one-time 30-day supply of KEVZARA.

QUESTIONS?
Call TheraCom at 855-417-7859.

Download the KEVZARA Experience Voucher Form below to order a 30-day sample of KEVZARA for your patients*


  • KEVZARA Experience Voucher Form
  • Download
  • *The KEVZARA Experience Voucher Program is available only for healthcare professionals and prescribing offices who do not or cannot accept samples.

KevzaraConnect® COPAY PROGRAM

As little as $0 copay for eligible patients
Commercially eligible patients may pay as little as $0 per month for therapy, up to an annual maximum of $15,000, subject to additional terms and conditions.*

Eligibility
  • KEVZARA has been prescribed for an indication approved by the FDA
  • Patient is a resident of the 50 United States, the District of Columbia, or Puerto Rico
  • Patient is aged ≥18 years
  • Patient has commercial insurance and is not covered under any government healthcare program
Enrollment
There are flexible options for enrollment and adjudication in the Copay Card Program

Patients can enroll in the program and receive membership information by:

Enrolling in the Copay Card Program at KEVZARA.com

Activating a physical copay card provided by their physician

Calling KevzaraConnect at 1-844-KEVZARA (1-844-538-9272)

  • *This program is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, Veterans Affairs, Department of Defense, TRICARE, or similar federal or state programs, including any state pharmaceutical assistance program. See full program terms and conditions.

KevzaraConnect® PATIENT ASSISTANCE PROGRAM

The Patient Assistance Program provides KEVZARA at no cost for up to 12 months to eligible uninsured, underinsured, and certain Medicare Part D patients if additional eligibility requirements are met.

Enrollment

If you have patients who may meet eligibility requirements and would like to enroll in the program, they must contact KevzaraConnect (1-844-538-9272).

KevzaraConnect® TOOLS

  • KEVZARA Experience Voucher Form
  • Download
  • Patient Assistance Program Application
  • Download
  • Sample Letter Template: Medical Necessity
  • Download
  • Sample Letter Template: Appeals
  • Download

KEVZARA sample letters are included to help provide the type of information that may be useful when responding to a health plan. These letters provide an example of the types of information that may be provided when responding to a request from a patient's health plan to provide either a letter of appeal or a letter of medical necessity of KEVZARA. Use of the information in these letters does not guarantee that the health plan will cover KEVZARA and is not intended to be a substitute for or an influence on the independent medical judgment of the physician.