Financial Assistance Banner
INJECTAFER Savings Program Tab Contnet
Copay savings may help reduce eligible patients’ out-of-pocket costs*
For eligible patients
- Assistance of up to $500 per dose
- Enrollment is valid for 2 courses of treatment per 12-month period
Is your patient eligible?*
Has commercial insuranceAND
Is a resident of the USA or its territories, including Puerto Rico
Has Medicare, Medicaid, or other federal or state healthcare insuranceOR
Has private indemnity or HMO insurance that reimburses patients for the entire cost of prescription drugsOR
Is Medicare-eligible and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees
Register your office by calling Daiichi Sankyo Access Central (1-866-4-DSI-NOW)
- Daiichi Sankyo Access Central will provide you with a login for injectafercopay.com
- Registration only needs to be completed once
Before administering Injectafer, enroll your patient
- Log in here (you can also enroll the patient at 1-866-4-DSI-NOW)
- Enter required patient information
- For each patient, you’ll receive a 16-digit code for a virtual debit card upon approval
After treatment, log in and submit EOB form
- Log in here
- Submit the Explanation of Benefits (EOB) form for the Injectafer treatment
- There are 3 ways to send the EOB form†:
Upload here★ Best way to submit EOBs and manage all patients OR
Fax to 1-888-257-4673OR
Injectafer Savings Program
100 Passaic Ave, Suite 245
Fairfield, NJ 07004
- It usually takes 2-3 days for EOB to be approved
- Then, funds will be uploaded onto the virtual 16-digit debit card
*The Injectafer Savings Program is only available for patients aged 1 year or older who are commercially insured. Please see full Terms and Conditions.
†When forms are uploaded to injectafercopay.com, the process may potentially be expedited. For patients who wish to directly submit their EOB form, please direct them to fax or mail the form to the Injectafer Savings Program.
Injectafer Savings Program Terms and Conditions
- This offer is valid for commercially insured patients. Uninsured and cash-paying patients are NOT eligible for this Program.
- Depending on insurance coverage, eligible patients may pay no more than $50 per dose for up to four doses per calendar year. There is a maximum savings limit of $500 per dose, with an overall program limit of $2,000 per calendar year. Check with your pharmacist or healthcare provider for your co-pay discount. Patient out-of-pocket expense may vary.
- This offer is not valid for patients enrolled in Medicare Part B or Medicare Part D, Medicaid, or other federal or state healthcare programs, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees.
- An explanation of benefits (EOB) statement must be faxed, uploaded in the portal, or mailed in prior to transacting on the account numbers for co-pay assistance.
- Offer is invalid for claims or transactions more than 180 days from the date on the EOB.
- Patients will be automatically re-enrolled in the next calendar year. If there is no copay claim activity for 18 months, the enrollment will be canceled.
- Daiichi Sankyo, Inc. reserves the right to rescind, revoke or amend this offer without notice. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers.
- Void if prohibited by law, taxed, or restricted.
- This account number is not transferable. The selling, purchasing, trading, or counterfeiting of this account number is prohibited by law.
- This account number is not insurance.
- By redeeming this account number, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
- Qualified patients receiving Injectafer will be allowed a 180-day retroactive enrollment period from the date of EOB (eligibility of benefit form) to receive benefits under the program rules.
Q: What is the Injectafer Savings Program?
A: The Injectafer Savings Program helps patients being treated with Injectafer with their prescription out-of-pocket responsibility.
Q: Is the Injectafer Savings Program only valid on Injectafer prescriptions?
A: Yes, the program can only be used toward 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. A patient can save a maximum benefit of up to $1000 per course of treatment. Enrollment is valid for 2 courses of treatment per 12-month period.
Q: Which patients are eligible to participate?
A: Commercially insured patients are eligible to enroll. Cash-paying patients and 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. The offer is valid for 2 courses of an Injectafer prescription. An explanation of benefits statement must be faxed, uploaded in the portal, or mailed in prior to transacting on the account numbers for assistance. One enrollment is allowed per 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 or you can enroll the patient on their behalf. 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. Once this information is received, the claims department will load funds to the virtual card within 2-3 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. There are 3 ways to send the EOB form: 1. Upload at injectafercopay.com (this is the best way to submit EOBs and manage all patients); 2. Fax to 1-888-257-4673; 3. Mail to Injectafer Savings Program, 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. To do this, you will need a check request form. (The best place to get the form is online at injectafercopay.com or, alternately, by calling 1-866-4-DSI-NOW.) If your office requires a 3-digit security code for processing, please call us at 1-877-448-4766.
Q: What if I administer Injectafer before my patient has enrolled in the Savings Program?
A: Qualified patients receiving Injectafer will be allowed a 120-day retroactive enrollment period to receive benefits under the program rules.
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.