KevzaraConnect^®

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

REQUEST SAMPLES

KevzaraConnect® is a patient support program for KEVZARA® (sarilumab) patients.

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

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.

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

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^® ENROLLMENT

Enrolling in KevzaraConnect is the first step to connecting your patients to access support throughout their treatment journey
You can work directly with KevzaraConnect to connect your patients with a Nurse Educator or, if eligible, timely access to Quick Start, Patient Assistance Program, or Copay Card. To connect patients to KevzaraConnect support services, enroll your patient in KevzaraConnect by obtaining the patient’s certification of enrollment and HIPAA authorization.

Three convenient options for enrolling your patients in KevzaraConnect:

Option 1

HCP faxes enrollment form

Step 1: HCP and patient complete the enrollment form, including HIPAA consent from patient

Step 2: HCP faxes the form to KevzaraConnect at 1-844-538-8960

Option 2

Patient enrolls online

Step 1: Patient completes KevzaraConnect online enrollment at KEVZARA.com

Step 2: A Nurse Educator will contact the patient to obtain HIPAA consent

Option 3

Patient calls KEVZARA

Step 1: Patient calls KevzaraConnect at 1-844-KEVZARA (1-844-538-9272)

Step 2: A Coordinator will work with the patient to complete enrollment and obtain HIPAA consent

A completed enrollment form provides:

Access to Nurse Educators who can provide product and disease education, as well as supplemental injection training
Assessment of Quick Start eligibility and enrollment
Assessment of Copay Card eligibility and enrollment
Access to a Patient Starter Kit and travel support
Access to Benefit Verification, Prior Authorization, and Coverage Support

For more information, call KevzaraConnect at 1-844-KEVZARA (1-844-538-9272) Option 1, Monday-Friday, 8AM-8PM EST

ESSENTIAL FORMS AND TEMPLATES FOR KevzaraConnect^®

KevzaraConnect Enrollment Form
Download English Version
Download Spanish Version

This form is designed to be easily completed by you and your patients. Once the entire enrollment form is completed and signed by you and your patient, fax pages 1 through 4 to 1-844-538-8960.

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 for 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.

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

Manual Reimbursement Form
Download

Copay Card Brochure
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.

NEXT: KEVZARA RESOURCES

INDICATION

KEVZARA is indicated for treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to one or more disease-modifying antirheumatic drugs (DMARDs).

IMPORTANT SAFETY INFORMATION

WARNING: RISK OF SERIOUS INFECTIONS

Patients treated with KEVZARA are at increased risk for developing serious infections that may lead to hospitalization or death. Opportunistic infections have also been reported in patients receiving KEVZARA. Most patients who developed infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.

Avoid use of KEVZARA in patients with an active infection.

Reported infections include:

Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Patients should be tested for latent tuberculosis before KEVZARA use and during therapy. Treatment for latent infection should be initiated prior to KEVZARA use.
Invasive fungal infections, such as candidiasis, and pneumocystis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease.
Bacterial, viral and other infections due to opportunistic pathogens.

Closely monitor patients for signs and symptoms of infection during treatment with KEVZARA. If a serious infection develops, interrupt KEVZARA until the infection is controlled.

Consider the risks and benefits of treatment with KEVZARA prior to initiating therapy in patients with chronic or recurrent infection.

CONTRAINDICATION

Do not use KEVZARA in patients with known hypersensitivity to sarilumab or any of the inactive ingredients.

WARNINGS AND PRECAUTIONS

Infections. Serious and sometimes fatal infections due to bacterial, mycobacterial, invasive fungal, viral, or other opportunistic pathogens have been reported in patients receiving immunosuppressive agents for rheumatoid arthritis (RA). The most frequently observed serious infections with KEVZARA included pneumonia and cellulitis. Among opportunistic infections, TB, candidiasis, and pneumocystis were reported with KEVZARA.
- Hold treatment with KEVZARA if a patient develops a serious infection or an opportunistic infection.
- Patients with latent TB should be treated with standard antimycobacterial therapy before initiating KEVZARA. Consider anti-TB therapy prior to initiation of KEVZARA in patients with a past history of latent or active TB in whom an adequate course of treatment cannot be confirmed, and for patients with a negative test for latent TB but having risk factors for TB infection.
- Consider the risks and benefits of treatment prior to initiating KEVZARA in patients who have: chronic or recurrent infection, a history of serious or opportunistic infections, underlying conditions in addition to RA that may predispose them to infection, been exposed to TB, or lived in or traveled to areas of endemic TB or endemic mycoses.
- Viral reactivation has been reported with immunosuppressive biologic therapies. Cases of herpes zoster were observed in clinical studies with KEVZARA.
Laboratory Abnormalities. Treatment with KEVZARA was associated with decreases in absolute neutrophil counts (including neutropenia), and platelet counts; and increases in transaminase levels and lipid parameters (LDL, HDL cholesterol, and/or triglycerides). Increased frequency and magnitude of these elevations were observed when potentially hepatotoxic drugs (e.g., MTX) were used in combination with KEVZARA. Assess neutrophil count, platelet count, and ALT/AST levels prior to initiation with KEVZARA. Monitor these parameters 4 to 8 weeks after start of therapy and every 3 months thereafter. Assess lipid parameters 4 to 8 weeks after start of therapy, then at 6 month intervals.
Gastrointestinal Perforation. GI perforation risk may be increased with concurrent diverticulitis or concomitant use of NSAIDs or corticosteroids. Gastrointestinal perforations have been reported in clinical studies, primarily as complications of diverticulitis. Promptly evaluate patients presenting with new onset abdominal symptoms.
Immunosuppression. Treatment with immunosuppressants may result in an increased risk of malignancies. The impact of treatment with KEVZARA on the development of malignancies is not known but malignancies have been reported in clinical studies.
Hypersensitivity Reactions. Hypersensitivity reactions have been reported in association with KEVZARA. Hypersensitivity reactions that required treatment discontinuation were reported in 0.3% of patients in controlled RA trials. Injection site rash, rash, and urticaria were the most frequent hypersensitivity reactions. Advise patients to seek immediate medical attention if they experience any symptoms of a hypersensitivity reaction. If anaphylaxis or other hypersensitivity reaction occurs, stop administration of KEVZARA immediately. Do not administer KEVZARA to patients with known hypersensitivity to sarilumab.
Active Hepatic Disease and Hepatic Impairment. Treatment with KEVZARA is not recommended in patients with active hepatic disease or hepatic impairment, as treatment with KEVZARA was associated with transaminase elevations.
Live Vaccines. Avoid concurrent use of live vaccines during treatment with KEVZARA due to potentially increased risk of infections. No data are available on the secondary transmission of infection from persons receiving live vaccines to patients receiving KEVZARA.

ADVERSE REACTIONS

The most common serious adverse reactions were infections. The most frequently observed serious infections included pneumonia and cellulitis. The most common adverse reactions (occurred in at least 3% of patients treated with KEVZARA + DMARDs) are neutropenia, increased ALT, injection site erythema, upper respiratory infections, and urinary tract infections.

DRUG INTERACTIONS

Exercise caution when KEVZARA is co-administered with CYP substrates with a narrow therapeutic index (e.g. warfarin or theophylline), or with CYP3A4 substrates (e.g. oral contraceptives or statins) as there may be a reduction in exposure which may reduce the activity of the CYP3A4 substrate.
Elevated interleukin-6 (IL-6) concentration may down-regulate CYP activity such as in patients with RA and hence increase drug levels compared to subjects without RA. Blockade of IL-6 signaling by IL-6Rα antagonists such as KEVZARA might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to altered drug concentrations.

USE IN SPECIFIC POPULATIONS

KEVZARA should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Because monoclonal antibodies could be excreted in small amounts in human milk, the benefits of breastfeeding and the potential adverse effects on the breastfed child should be considered along with the mother’s clinical need for KEVZARA.
There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to KEVZARA during pregnancy. Physicians are encouraged to register patients and pregnant women are encouraged to register themselves by calling 1-877-311-8972.
Use caution when treating the elderly.

Advise patients to read the FDA-approved patient labeling (Medication Guide and Instructions for Use).

Please click here to see full Prescribing Information, including Boxed WARNING.

KevzaraConnect®

KEVZARA SAMPLE PROGRAM

KEVZARA EXPERIENCE VOUCHER PROGRAM

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

KevzaraConnect® COPAY PROGRAM

KevzaraConnect® ENROLLMENT

For more information, call KevzaraConnect at 1-844-KEVZARA (1-844-538-9272) Option 1, Monday-Friday, 8AM-8PM EST

ESSENTIAL FORMS AND TEMPLATES FOR KevzaraConnect®

KevzaraConnect® PATIENT ASSISTANCE PROGRAM

KevzaraConnect® TOOLS