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:
Eligible patients with commercial insurance may pay as little as $0 for LIBTAYO, which includes any product-specific copay, coinsurance, and insurance deductibles—up to $25,000 in assistance per year.† Conditions apply.
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.
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. This offer 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 2019, 500% of the FPL is $62,450 for a household of 1; $84,550 for a household of 2; $106,650 for a household of 3; and $128,750 for a household of 4. For households exceeding 4 members, add $22,100 for each additional member.1 Additional program conditions apply.
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.
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 health system or hospital-owned specialty pharmacies may order LIBTAYO directly from any of our authorized distributors.
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.
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 | |
| Product return flash card | |
| 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 | |
