Get started with support

Enroll now to take advantage of reimbursement support for your patients who have been prescribed POTELIGEO® (mogamulizumab-kpkc).

Enroll
Access and reimbursement

Receive assistance with access and reimbursement

Kyowa Kirin Cares helps to get your patients from prescription to therapy quickly and seamlessly. Once you enroll, an oncology nurse will assist your patients with access and reimbursement options. The process is simple:

  • Download the Kyowa Kirin Cares enrollment form, fill it out with your patient’s information, and fax it to 833-267-5848.

  • Upon receiving the completed enrollment form, a Kyowa Kirin Cares oncology nurse will begin the benefits investigation (BI) process for your patient.

  • Within 2 business days, you will be informed of the outcome of the BI process. If Poteligeo is covered by your patient’s insurance, the oncology nurse will fax you a BI summary. If an appeal or prior authorization is required, the oncology nurse will call to inform you of this.

Through Kyowa Kirin Cares, access options are available for patients

A Kyowa Kirin Cares oncology nurse can help your patients navigate their access options—regardless of their insurance coverage.

Commercial insurance

Kyowa Kirin offers co-pay assistance for eligible commercially insured patients. Review the co-pay assistance terms and conditions to determine if your patients with commercial insurance qualify. a,b

Government insurance

In most cases, Kyowa Kirin does not offer a program for patients with government or military insurance.c A Case Manager may be able to refer these patients to independent charitable foundations and/or educate them on federal plan selections.

No insurance

Kyowa Kirin offers a Patient Assistance Program for eligible uninsured patients.c Download the application to review the terms and conditions and determine if your patients without insurance qualify.d

aPatients must be US residents with an active primary commercial plan; patients with federal or state government insurance such as Medicare, Medicaid, and Tricare are not eligible for co-pay assistance. Other terms and conditions may apply.

bCommercially insured patients do not need to participate in Kyowa Kirin Cares to be eligible for co-pay assistance.

cPatients who do not meet the Patient Assistance Program coverage criteria and have special circumstances of financial and/or medical hardship, as determined in accordance with Kyowa Kirin Cares criteria, can request that an exception be made for them. The decision to grant an exception is based on an individual's unique circumstances and is made solely at the discretion of Kyowa Kirin.

dPatients must be US residents with no active medical or pharmacy benefit insurance and an annual gross income ≤400% of the federal poverty level, confirmed by electronic income verification response or documented proof of income.

Call 833-KK-CARES (833-552-2737)

Monday through Friday, 8 am to 8 pm (ET)

Ongoing support

Connect your patients with ongoing support

Kyowa Kirin Cares partners with you to provide your patients with personalized and ongoing support throughout their journeys with POTELIGEO. A dedicated oncology nurse will be available to:

Answer questions about the infusion experience

Answer general questions about POTELIGEO

Provide external resources, when applicable

Help patients manage barriers to adherence

By enrolling in Kyowa Kirin Cares, you're providing a resource to your patients, especially those requiring financial assistance. However, if you choose not to enroll in Kyowa Kirin Cares, your patients can enroll on their own to take advantage of ongoing support from an oncology nurse.

The information provided by the oncology nurse to your patients is for informational purposes only and does not constitute medical advice. It is not intended to replace a discussion between you and your patient. All decisions regarding patient care must be made by a patient's healthcare provider considering the unique characteristics of each patient.

POTELIGEO resources

Get your hands on important forms and resources

Access Kyowa Kirin Cares forms as well as useful Poteligeo information and resources.

Enrollment

Download the Kyowa Kirin Cares prescription and enrollment form to get enrolled.

download

Uninsured patients

Download the Patient Assistance Program application for your uninsured patients.

download

About POTELIGEO

Visit the POTELIGEO website to learn about efficacy, safety, dosing, and more.

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Medical necessity

Download and use this template letter of medical necessity for appropriate patient cases.

download

Appeal letter

Download and use this appeal template letter for your patients who have been denied coverage.

download

Support brochure

Download this Kyowa Kirin Cares brochure and use it as a quick reference for program offerings.

download

Indication

POTELIGEO® (mogamulizumab-kpkc) injection for intravenous infusion is indicated for the treatment of adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after at least one prior systemic therapy.

Important Safety Information

Warnings and Precautions:

  • Dermatologic toxicity: Monitor patients for rash throughout the course of treatment. For patients who experienced dermatologic toxicity in Trial 1, the median time to onset was 15 weeks, with 25% of cases occurring after 31 weeks. Interrupt Poteligeo for moderate or severe rash (Grades 2 or 3). Permanently discontinue Poteligeo for life-threatening (Grade 4) rash or for any SJS or TEN.

  • Infusion reactions: Most infusion reactions occur during or shortly after the first infusion. Infusion reactions can also occur with subsequent infusions. Monitor patients closely for signs and symptoms of infusion reactions and interrupt the infusion for any grade reaction and treat promptly. Permanently discontinue Poteligeo for any life-threatening (Grade 4) infusion reaction.

  • Infections: Monitor patients for signs and symptoms of infection and treat promptly.

  • Autoimmune complications: Interrupt or permanently discontinue POTELIGEO as appropriate for suspected immune-mediated adverse reactions. Consider the benefit/risk of POTELIGEO in patients with a history of autoimmune disease.

  • Complications of allogeneic HSCT after Poteligeo: Increased risks of transplant complications have been reported in patients who received allogeneic HSCT after POTELIGEO. Follow patients closely for early evidence of transplant-related complications.

Adverse Reactions:

  • The most common adverse reactions (reported in ≥ 10% of patients) with Poteligeo in the clinical trial were infusion reaction (33%), fatigue (31%), diarrhea (28%), drug eruption (24%), upper respiratory tract infection (22%), musculoskeletal pain (22%), skin infection (19%), pyrexia (17%), edema (16%), nausea (16%), headache (14%), thrombocytopenia (14%), constipation (13%), anemia (12%), mucositis (12%), rash (11%), cough (11%), and hypertension (10%).

You are encouraged to report suspected adverse reactions to Kyowa Kirin, Inc. at 1-844-768-3544 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see full Prescribing Information.