Financial support

to help you get your factor

Financial or insurance questions shouldn't come between you and your factor

If you and your healthcare provider have decided that ALPROLIX might be a good option for you, your MyALPROLIX™ Coordinator will work with you and your existing healthcare team and pharmacy to help find options for you and coordinate access to therapy with ALPROLIX.

To get started with the Free Trial Plus Program:
Complete the FREE TRIAL PLUS ENROLLMENT FORM
and bring it to your HCP
Try ALPROLIX for 3O days - FREE

With the Free Trial Plus Program, you may be able to receive a 30-day supply of free ALPROLIX. You may also be eligible to receive free ALPROLIX for up to 1 year, if needed, until your healthcare coverage begins.

Initiate treatment with ALPROLIX under the supervision of a qualified healthcare provider experienced in the treatment of hemophilia B.

Eligibility:

  • This is your first prescription of ALPROLIX
  • You are uninsured, or
  • You are insured, with the exception of government healthcare coverage, such as Medicare, Medicaid, or Tricare
  • Other restrictions may apply

If you and your HCP decide to use ALPROLIX, here's how it works:

  • Download, complete, and sign the Free Trial Plus Enrollment Form and bring it to your HCP
  • Your HCP will submit the form to MyALPROLIX Services
  • A MyALPROLIX Coordinator will contact you within 2 business days to confirm coverage and delivery details
  • If eligible, your 30-day supply will be shipped to you within 24 hours
  • Biogen will continue to provide you with ALPROLIX for free until your insurance coverage begins, for up to one year

To get started with the Copay Program, Factor Access Program, or Insurance Counseling:
OR
Call 1-855-MyALPROLIX (692-5776)
Monday through Friday 8 AM to 8 PM, ET
Save on out-of-pocket costs with our Copay Program

The Copay Program offers eligible patients savings up to $12,000 per year on out-of-pocket costs associated with your prescription of ALPROLIX, whether you are new to ALPROLIX or already on therapy.

Your MyALPROLIX Coordinator can work with you, as well as your existing healthcare providers, pharmacy, and home healthcare team. Together, we can help you with your copay benefits and provide assistance in identifying any other coverage options that you may need.

  • This program does not cover costs if you are on government healthcare coverage, such as Medicare, Medicaid, and Tricare
  • There are no income requirements or caps
  • Not responsible for costs associated with administration of therapy, such as office visits, infusion costs, or other professional services

Biogen reserves the right to rescind, revoke, or amend this offer without notice.

Eligibility:

  • You have commercial health insurance
  • Other restrictions may apply
  • US prescriber and pharmacy required

Here's how it works:

  • Download, complete, and sign the MyALPROLIX Enrollment Form or call MyALPROLIX at 1-855-MyALPROLIX (692-5776)
  • Fax the completed form to 1-855-398-7634
  • A MyALPROLIX Coordinator will contact you within 2 business days to provide information about your eligibility
  • If eligible, you may receive assistance with your out-of-pocket costs
Factor Access Program helps with caps and gaps in your insurance

There are different reasons why you may find yourself in a situation where your insurance coverage for long-term therapy, such as ALPROLIX, may be interrupted. You may be between jobs, or changing insurers. Or, you might reach the lifetime insurance cap or your annual dollar limit.

Whatever the situation, your MyALPROLIX Coordinator can answer your questions to help you get continued access to ALPROLIX.

Eligibility:

  • You may be eligible for the Factor Access Program if:
    – You have experienced a gap in your
    insurance coverage
    – You have reached your maximum insurance
    coverage limit
    – You have no prescription coverage
  • Other restrictions may apply

Here's how it works:

  • Download, complete, and sign the MyALPROLIX Enrollment Form or call MyALPROLIX at 1-855-MyALPROLIX (692-5776)
  • Fax the completed form to 1-855-398-7634
  • A MyALPROLIX Coordinator will contact you within 2 business days to provide information about your eligibility
  • If eligible, your ALPROLIX will be provided for free
Insurance Counseling

Understanding insurance coverage for long-term therapies, such as ALPROLIX, can be confusing. There are many different situations that can arise which can affect your coverage. Your MyALPROLIX Coordinator has experience in different areas of health insurance coverage and can help you navigate through the changing healthcare environment to help you better understand your coverage options.

Your MyALPROLIX Coordinator is your personal resource for answers to your insurance questions.

Here's how it works:

  • Download, complete, and sign the MyALPROLIX Enrollment Form or call MyALPROLIX at 1-855-MyALPROLIX (692-5776)
  • Fax the completed form to 1-855-398-7634
  • A MyALPROLIX Coordinator will contact you within 2 business days to discuss the results of your benefits investigation
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Free Trial Plus Program

  • Q

    Does ALPROLIX offer a free 30-day supply program?
  • Q

    How do I know if I'm eligible to receive a free 30-day supply of ALPROLIX?
  • Q

    Can I get a free 30-day supply if I'm already using ALPROLIX?

Copay Program

  • Q

    What is the Copay Program?
  • Q

    Is there a card I need to activate?
  • Q

    How do I start receiving my copay assistance?

Factor Access Program

  • Q

    I've reached my annual maximum insurance coverage limit. What can I do?
  • Q

    What if I have a lapse in my insurance coverage?

Insurance Counseling

  • Q

    What happens if my insurance company doesn't cover my bill?
  • Q

    Am I eligible for financial assistance if I have insurance?
  • Q

    I'm not sure what my insurance covers. Can you help?
  • Q

    What is prior authorization?
  • Q

    Why would my prior authorization be denied? What happens if my insurance won't approve me?
  • Q

    What if I am unable to afford the remaining costs not covered by my insurance?
  • Q

    Are there income requirements to qualify for financial assistance?



Indications
ALPROLIX [Coagulation Factor IX (Recombinant), Fc Fusion Protein] is a recombinant DNA derived, coagulation factor IX concentrate indicated in adults and children with Hemophilia B for:
  • On-demand treatment and control of bleeding episodes
  • Perioperative management of bleeding
  • Routine prophylaxis to reduce the frequency of bleeding episodes
ALPROLIX is not indicated for induction of immune tolerance in patients with Hemophilia B.
Important Safety Information

Do not use ALPROLIX if you are allergic to ALPROLIX or any of the other ingredients in ALPROLIX.

Tell your healthcare provider if you have or have had any medical problems, take any medicines, including prescription and non-prescription medicines, supplements, or herbal medicines, have any allergies and all your medical conditions, including if you are pregnant or planning to become pregnant, are breastfeeding, or have been told you have inhibitors (antibodies) to factor IX.

Allergic reactions may occur with ALPROLIX. Call your healthcare provider or get emergency treatment right away if you have any of the following symptoms: difficulty breathing, chest tightness, swelling of the face, rash, or hives.

Your body can also make antibodies called “inhibitors” against ALPROLIX, which may stop ALPROLIX from working properly.

ALPROLIX may increase the risk of formation of abnormal blood clots in your body, especially if you have risk factors for developing clots.

Common side effects of ALPROLIX include headache and abnormal sensation of the mouth. These are not all the possible side effects of ALPROLIX. Talk to your healthcare provider right away about any side effect that bothers you or does not go away, and if bleeding is not controlled using ALPROLIX.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see full Prescribing Information.