Get your
patients started
with support
Enroll
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ACCESS OPTIONS TO GET YOUR PATIENT ON TREATMENT
Kyowa Kirin Cares helps to get eligible patients from prescription to treatment. When enrollment is completed, a dedicated Case Manager can assist your patients with understanding their insurance coverage benefits and getting started on POTELIGEO.
To get started on enrollment
- 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 Case Manager 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 Case Manager will fax you a BI summary. If an appeal or prior authorization is required, the Case Manager will call to inform you of this
Help patients understand their access options
Through Kyowa Kirin Cares, a dedicated Case Manager can help your patients understand their financial support options.
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
Government insurance
Kyowa Kirin does not offer a program for patients with government insurance, such as Medicare, Medicaid, and TRICARE. If your patient has government insurance, a Case Manager can help them navigate available financial options.b
No insurance
Kyowa Kirin offers a Patient Assistance Program for eligible uninsured patients. Download the application to review the terms and conditions to determine if your patients without insurance qualify.c
- a Patients 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.
- b It is important to note that external support options that may be able to provide financial support manage their own eligibility criteria and evaluation process and are independent from Kyowa Kirin Cares and its affiliates. Kyowa Kirin Cares cannot guarantee that a patient will receive assistance.
- c Patients must be US residents with no active medical or pharmacy benefit insurance and meet the income criteria.
Call 833-KK-CARES
(833-552-2737)
Monday through Friday, 8 AM
to 8 PM (ET)
CONNECT YOUR PATIENTS TO A DEDICATED CASE MANAGER
Kyowa Kirin Cares can provide your patients with support throughout their treatment with POTELIGEO. A dedicated Case Manager will be available to:
Help your patients get started on treatment
- Benefits investigation
- Information about prior authorization
Help your patients understand their financial options
- Navigate available programs for eligible patients
Provide
helpful
information
- Answers to general questions about POTELIGEO
- Educational resources
Support your patients throughout their treatment
- Check-in calls from a dedicated Case Manager
The information provided by the Case Manager 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 a patient's care are made by the patient's healthcare provider(s), who is the primary point of contact.
IMPORTANT FORMS AND RESOURCES
Enrollment
Download the Kyowa Kirin Cares prescription and enrollment form to get your patients enrolled.
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Uninsured patients
Download the Patient Assistance Program application for your uninsured patients.
Jeff is a real patient.
About POTELIGEO
Visit the POTELIGEO website to learn about efficacy, safety, dosing, and more.
Medical necessity sample letter
Download this sample letter of medical necessity as guidance to use for appropriate patient cases.*
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Appeal sample letter
Download this sample letter of appeal as guidance to use for your patients who have been denied coverage.*
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Support brochure
Download this Kyowa Kirin Cares brochure and use it as a quick reference for program offerings.
- *The accurate completion of coverage related documentation or reimbursement is the responsibility of the healthcare provider and patient. Kyowa Kirin Cares makes no guarantee regarding reimbursement for any product or service.
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:
- Infusion reactions:
- Infections:
- Autoimmune complications:
- Complications of allogeneic HSCT after Poteligeo:
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.
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.
Monitor patients for signs and symptoms of infection and treat promptly.
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.
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.