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patient access and reimbursement support program

LIBTAYO Surround helps eligible patients access LIBTAYO and navigate the health insurance process. Click here for downloadable resources.

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Patient support

LIBTAYO Surround offers patient support that may facilitate access to medication when patients need assistance with out-of-pocket costs. A LIBTAYO Surround Reimbursement Specialist will help investigate your patients’ eligibility for the following programs:

LIBTAYO Surround Commercial Copay Program*

Eligible patients with commercial insurance may pay $0 for LIBTAYO, which includes any product-specific copay, coinsurance, and insurance deductibles—up to $25,000 in assistance per year. Conditions apply.

There is no income requirement to qualify for this program.
LIBTAYO Surround Patient Assistance Program

Eligible patients who meet income requirements and are uninsured, lack coverage for LIBTAYO, or have Medicare Part B with no supplemental insurance coverage may receive LIBTAYO at no cost.

Information about potential alternate sources of coverage

Patients without insurance coverage or patients with inadequate insurance coverage who need assistance with out-of-pocket medication costs may be eligible for alternate sources of funding for LIBTAYO.

*Subject to annual maximum copay assistance amount of $25,000. This program is not valid for prescriptions covered by or submitted for reimbursement under Medicare, Medicaid, Veterans Affairs/Department of Defense, TRICARE, or similar federal or state programs. Not a debit card program. The program does not cover or provide support for supplies, procedures, or any physician-related service associated with LIBTAYO. General non–product-specific copays, coinsurance, or insurance deductibles are not covered. This program only applies to patients who are at least 18 years of age, residents of the United States or its territories or possessions, are prescribed LIBTAYO (cemiplimab-rwlc) for an FDA-approved indication, and are insured by a commercial health plan that requires a copayment, coinsurance and/or deductible amount for LIBTAYO. It is not an insurance benefit. LIBTAYO SurroundTM reserves the right to rescind, terminate, or amend this offer, eligibility, and terms and conditions at any time without notice. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. This offer is not conditioned on any past, present or future purchase, including refills. The copay card is non-transferable, limited to one per person, and cannot be combined with any other offer or discount. This program is not valid where prohibited by law, taxed or restricted. Offer has no cash value. Program is not valid for cash paying customers. Additional program conditions may apply.

Patients are responsible for any out-of-pocket costs for LIBTAYO that exceed the program assistance limit of $25,000 per year.

Patients must have an annual gross household income that does not exceed the greater of $100,000 or 500% of the federal poverty level (FPL). In 2018, 500% of the FPL was $60,700 for a household of 1; $82,300 for a household of 2; $103,900 for a household of 3; and $125,500 for a household of 4. For households exceeding 4 members, add $21,600 for each additional member.1 Additional program conditions apply.

  1. Office of the Assistant Secretary for Planning and Evaluation. Poverty guidelines. US Department of Health and Human Services website. https://aspe.hhs.gov/poverty-guidelines. Accessed July 2, 2018.

Access and reimbursement support

LIBTAYO Surround can provide assistance with access and reimbursement to help your patients receive their medication as quickly as possible. Upon receipt of a LIBTAYO Surround enrollment form, a LIBTAYO Surround Reimbursement Specialist can provide several forms of assistance.

Benefits investigations

  • How LIBTAYO will be covered under your patient's health plan
  • Acquisition options
  • A patient's eligibility for financial assistance
  • Additional coverage information to facilitate your patient's access to LIBTAYO

Additional service offerings, including:

  • Prior authorization (PA) assistance to review and explain payer requirements
  • Appeals support when PA is denied
  • Claims assistance for billing and reimbursement as you prepare claims and to review the status of claims with your patient's health insurer

Product support

LIBTAYO Surround provides support in connection with product ordering.

You can order LIBTAYO from any of our authorized distributors (buy and bill).

In certain cases, a payer may direct your office, or your office may choose, to obtain LIBTAYO from a specialty pharmacy. We have one contracted specialty pharmacy for dispensing LIBTAYO.

Certain payer-mandated health system or hospital-owned specialty pharmacies may order LIBTAYO directly from any of our authorized distributors.

You can access an array of patient support services through LIBTAYO Surround

For more information, call 1.877.LIBTAYO (1.877.542.8296)(1.877.542.8296), option 1, Monday-Friday, 8 AM-8 PM Eastern Time.

Support tools for LIBTAYO

Download these resources and tools for information on how to facilitate access, coverage, and reimbursement for LIBTAYO.

LIBTAYO Surround Patient Support Program
Enrollment form
LIBTAYO Surround overview
LIBTAYO Surround patient financial support resources
These resources provide information about the options available to help eligible patients access LIBTAYO when they need assistance with out-of-pocket costs.
Copay Program for eligible commercially insured patients
Patient Assistance Program
Alternative sources of coverage for LIBTAYO
Financial assistance programs
Access, billing, and reimbursement resources
LIBTAYO Surround provides assistance with access, billing, and reimbursement.
Quick reference coding guide
Billing and coding essentials
Sample annotated CMS forms
Product acquisition flash card
Copay Program reimbursement guide
Copay Program reimbursement fax cover sheet
Support tools to facilitate access to LIBTAYO
LIBTAYO Surround provides information on how to facilitate access, coverage, and reimbursement for LIBTAYO.
Prior authorization checklist
Appeal checklist and sample letter
Sample letter of medical necessity
Sample letter of medical exception