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Prescription assistance for your customers

There are several programs to help ensure that a financial burden won’t keep high-risk children from getting the protection they deserve. If you have a customer who needs assistance paying for Synagis, they may qualify for support such as the Synagis Copay Savings Program, AZ&Me™, or support from an Independent Non-Profit Organization (INO). Be sure that the patient’s healthcare provider is aware of available assistance programs, as well as their eligibility requirements.

Click here to find out more about referral and reimbursement and support with Access 360™. Access 360 is a program designed to support the referral process through a team of dedicated specialists that can assist in identification of coverage specific to AstraZeneca specialty products.

Synagis Copay
Savings Program

PROGRAM DESCRIPTION

Assists qualified commercially insured Synagis patients with their Synagis copays:

  • Eligible patients may have access to a virtual debit account funded with up to $2,000
    to assist with Synagis out-of-pocket costs

  • Patients are responsible for the first $30 of each Synagis dose

Eligibility (Must meet all criteria)

  • Patients with a copay/coinsurance >$30

  • Patients not covered by Medicaid, TriCare, or other state or federal government healthcare programs

  • Patients with a prescription for Synagis that is consistent with the product label

Additional Information

Phone: 1-844-ASK-A360

Website: www.myaccess360.com

AZ&Me

AZ&Me

For additional information on the AZ&Me Prescription Savings Program, call 1-800-AZandMe or visit www.AZandMe.com.

INO*

PROGRAM DESCRIPTION

Facilitates access to medical care for patients with chronic or life-threatening illnesses. INOs help patients overcome financial and other barriers to medical care. Some INOs have limitations on the types of medication covered.

Eligibility (Must meet all criteria)

Each INO has specific criteria for determining a patient’s eligibility to receive assistance.

Criteria may include:

  • Medical qualifications
  • Insurance coverage
  • Income requirements

Additional Information

For more information, or to be connected to an INO that may be able to help you,
please call Access 360 at 1-844-ASK-A360.

INOs are not affiliated with AstraZeneca. AstraZeneca makes no representations as to insurance coverage or financial support available through these programs. AstraZeneca provides a grant to the INOs and has no involvement or vested interest in how funds are disbursed.

Important Safety Information

Synagis® (palivizumab) is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. Safety and efficacy were established in children with bronchopulmonary dysplasia (BPD), infants with a history of premature birth (≤35 weeks gestational age), and children with hemodynamically significant congenital heart disease (CHD). The recommended dose of Synagis is 15 mg/kg of body weight given monthly by intramuscular injection. The first dose of Synagis should be administered prior to commencement of the RSV season and the remaining doses should be administered monthly throughout the RSV season. Children who develop an RSV infection should continue to receive monthly doses throughout the RSV season.

The efficacy of Synagis at doses less than 15 mg/kg, or of dosing less frequently than monthly throughout the RSV season, has not been established.

Synagis is contraindicated in children who have had a previous significant hypersensitivity reaction to Synagis. Cases of anaphylaxis and anaphylactic shock, including fatal cases, have been reported following initial exposure or re-exposure to Synagis. Other acute hypersensitivity reactions, which may be severe, have also been reported on initial exposure or re-exposure to Synagis. The relationship between these reactions and the development of antibodies to Synagis is unknown. If a significant hypersensitivity reaction occurs with Synagis, its use should be permanently discontinued. If a mild hypersensitivity reaction occurs, clinical judgment should be used regarding cautious readministration of Synagis. As with any intramuscular injection, Synagis should be given with caution to children with thrombocytopenia or any coagulation disorder. Palivizumab may interfere with immunological-based RSV diagnostic tests, such as some antigen detection-based assays.

Adverse reactions occurring greater than or equal to 10% and at least 1% more frequently than placebo are fever and rash. In post-marketing reports, cases of severe thrombocytopenia (platelet count <50,000/microliter) and injection site reactions have been reported.

Please see full Prescribing Information for Synagis, including Patient Information.