Financial Assistance Banner

Financial Assistance

Daiichi Sankyo Access Central offers financial assistance for eligible patients prescribed INJECTAFER. Talk to an Access Central Coordinator about how to help your patients access INJECTAFER.

fFinancial Assistance Tab

INJECTAFER Savings Program Tab Contnet

Copay assistance for eligible commercially insured patients prescribed INJECTAFER

Daiichi Sankyo Access Central helps patients being treated with INJECTAFER with their prescription out-of-pocket responsibility. INJECTAFER is the only IV iron that offers a copay savings program to help ensure patients have access to iron.*

Eligible patients can:

 

*As of June 2019.
Each dose is up to 750 mg of iron.

Program description

Qualifying commercially insured patients can receive up to $500 in assistance toward their out-of-pocket costs for each dose of INJECTAFER. Patients enrolled in Medicare, Medicaid, or other federal health care programs are not eligible. A single enrollment in the program covers up to 2 doses, or a maximum of $1000. If a patient receives more than 2 doses, he or she can re-enroll into the program within a 12-month period. In order for your patients to receive copay assistance, your practice must enroll in the INJECTAFER Savings Program. Please see the Terms and Conditions below.

Enroll your practice in the INJECTAFER Savings Program online or by calling an Access Central Coordinator (1-866-4-DSI-NOW).

Help your patients apply for the INJECTAFER Savings Program

In order for your patients to receive copay assistance, your practice must enroll in the INJECTAFER Savings Program. Once your practice is registered, you can apply on behalf of your patients by calling an Access Central Coordinator or using our online application. Patients can also apply by using the application or by calling an Access Central Coordinator, who will walk them through the application process.

INJECTAFER Savings Program Terms and Conditions

  1. This offer is valid for commercially insured as well as cash-paying patients.
  2. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, or private indemnity or HMO insurance plans that reimburse patients for the entire cost of their prescription drugs. Patients may not use this card if they are eligible for Medicare and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees.
  3. Depending on insurance coverage, eligible insured patients may pay as little as $50 for INJECTAFER for the first dose and $0 for INJECTAFER for the second dose, up to a maximum savings limit of $500 per dose, a $1000 program limit for coverage up to 2 doses. Patients will verify their copay discounts with their healthcare providers. Patient out-of-pocket expense may vary.
  4. The offer is valid for 1 course, or 2 doses, of an INJECTAFER prescription. An explanation of benefits statement must be faxed in prior to transacting on the account numbers for assistance. The account number may be used for additional course of therapy only after re-enrolling. One re-enrollment is allowed per 12-month period.
  5. Daiichi Sankyo, Inc., reserves the right to rescind, revoke, or amend this offer without notice.
  6. Offer good only in the USA, including Puerto Rico, at participating healthcare providers.
  7. Void if prohibited by law, taxed, or restricted.
  8. The patient's account number is not transferable. The selling, purchasing, trading, or counterfeiting of this account number is prohibited by law.
  9. The patient's account number is not insurance.
  10. By redeeming the account number, the patient acknowledges that he or she is an eligible patient and understands and agrees to comply with the terms and conditions of this offer.
  11. Qualified patients receiving INJECTAFER will be allowed a 30-day retroactive enrollment period to receive benefits under the program rules. Any patient wishing to receive this retroactive enrollment assistance must fill out the Eligibility Attestation Form to submit along with the claim from their initial treatment. This form must be completed prior to receiving any copay assistance.

Q: What is the INJECTAFER Savings Program?

A: The INJECTAFER Savings Program helps commercially insured patients being treated with INJECTAFER with their prescription out-of-pocket responsibility. Patients enrolled in Medicare, Medicaid, or any other federal healthcare program are not eligible.

Q: Is the INJECTAFER Savings Program only valid on INJECTAFER prescriptions?

A: Yes, the program can only be used towards a patient's prescription out-of-pocket responsibility for the INJECTAFER medication.

Q: How much can a patient save?

A: The program helps with up to $500 per dose after the patient has paid the first $50 of his or her out-of-pocket prescription responsibility for the first dose and $0 for the second dose. A single enrollment in the program covers up to 2 doses, or a max of $1000.

Q: Which patients are eligible to participate?

A: Eligible patients are 18 years or older. Commercially insured as well as cash-paying patients are eligible to enroll. Patients with drug coverage under any federally funded healthcare program, including but not limited to Medicare, Medicaid, TRICARE, or other state-funded programs (collectively FHCP), will be ineligible to participate.

Q: If I recommend additional therapy with INJECTAFER, can my patient still use the program?

A: Yes, if you recommend additional treatment with INJECTAFER, the program will help cover your patient's prescription out-of-pocket responsibility. Your patient will need to re-enroll before additional help can be provided. One re-enrollment is allowed per a 12-month period.

Q: How does the INJECTAFER Savings Program work?

A: An interested patient can visit the Savings Program website and enroll in the program. Alternatively, a provider can apply for a patient. Following confirmation of eligibility, an INJECTAFER Savings Program virtual debit card number will be issued to the patient; that number is then given to the patient's healthcare provider. The Savings Program requires that once the patient receives each dose, an explanation of benefits or itemized statement from his or her healthcare provider be sent to the program via fax, mail, or the upload tool. The program fax number is 1-888-257-4673 and the mailing address is 100 Passaic Ave, Suite 245, Fairfield, NJ 07004. Once this information is received, the claims department will load funds to the virtual card within 2 business days.

Q: Is proof of purchase necessary?

A: Yes. After each dose, you and your patient will receive an explanation of benefits form from your patient's insurance provider. This document will need to be sent to the program to load funds to the patient's virtual debit card. Your patient may fax the explanation of benefits to the dedicated INJECTAFER Savings Program fax line, 1-888-257-4673. This information may also be uploaded to the INJECTAFER Savings Program website. You may also mail this information to the program at 100 Passaic Ave, Suite 245, Fairfield, NJ 07004.

Q: What happens if an explanation of benefits is not sent in?

A: The funds will not be available to the patient until this documentation is submitted.

Q: What do I do if my practice cannot process credit or debit cards?

A: In situations where a dispensing entity does not accept debit or credit card payments, the program will provide reimbursement for the patient's eligible out-of-pocket expense in accordance with the program via paper check upon receiving a receipt of the incurred out-of-pocket expense for INJECTAFER. If your office requires a 3-digit security code for processing, please call us at 1-866-4-DSI-NOW.

Q: What if I administer INJECTAFER before my patient has enrolled in the Savings Program?

A: Patients can enroll up to 30 days after the first INJECTAFER treatment and utilize a retroactive enrollment period for assistance on dates of service that took place prior to enrollment. In order to utilize this retroactive enrollment period, the patient must be successfully enrolled in the program and have filled out the Eligibility Attestation Form, located in the Forms section of the Savings Program website. Once this is done, please ensure that the patient submits all corresponding documentation so that his or her virtual card will be loaded with funds for the retroactive date. The form and corresponding documentation can be submitted via fax to 1-888-257-4673 or mailed to 100 Passaic Ave, Suite 245, Fairfield, NJ 07004.

The completion and submission of coverage- or reimbursement-related documentation is the responsibility of the patient and healthcare provider. Daiichi Sankyo, Inc., makes no representation or guarantee concerning coverage or reimbursement for any service or item. A completed form includes signatures from both the physician and the patient. Before submitting, please ensure all required information is provided.