Starting your Patient

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Starting your Patients: A Step by Step Guide

GILOTRIF Patient Services–Brought you by Accredo®

 

Prescribing GILOTRIF for Non-dispensing Accounts

  1. Get a GILOTRIF prescription form*
     Download Enrollment Form

    Or, contact Accredo® at 1-844-569-2836, or contact your sales consultant
     

  2. Complete and fax the form to Accredo® at 1-888-454-8488
     
  3. Once GILOTRIF prescription enrollment is complete, your patients will receive a welcome call, confirming enrollment and insurance benefits.

    The first delivery often arrives within 4 days. Upon receiving the prescription and enrollment form, Accredo® will fill the prescription and call your patients to schedule their GILOTRIF delivery.

Gilotrif enrollment form

*Some states may require a separate prescription.

 

Highlights within GILOTRIF Patient Services include:

 

Co-pay Assistance Program

  • Eligible commercially insured patients 18 years or older could pay as little as $0/month with a maximum savings up to $5,500 monthly and a maximum annual program benefit of $25,000.

†Co-pay Assistance Program is only available to commercially insured patients.

 

 

Bridge Program

  • Eligible patients experiencing more than a 5-day payer approval delay can receive a 15-day supply of GILOTRIF at no cost to the patient for the FDA-approved indications

 

 

GILOTRIF Dose Exchange™

  • Facilitates transition to a new dose at no cost to your patients§
  • Eliminates additional GILOTRIF co-pay in a given month for eligible patients
  • Eligible patients receive a new dose of GILOTRIF
         - Convenient packaging to return unused tablets
         - Call 1-844-569-2836 to learn more

 

§GILOTRIF Dose Exchange™ covers up to 2 dose modifications for patients serviced through Accredo® or GILOTRIF Dispensing Network who have 9 or more tablets to exchange.

 

 

Your Patient’s Roadmap once enrolled:

Patients will receive a welcome call, program overview, and GILOTRIF delivery schedule starting on Day 1. Nurses will continue to reach out to patients to help enhance patient adherence as needed.
 
 
Patients can reach an Accredo® representative Monday–Friday from 8am to 8pm EST by calling 1‑844‑569‑2836.
 
Communication with patients may vary based on individual patient need and availability.

 

Non-dispensing Accounts Guide

 Download Non-dispensing Accounts Guide

 

 

For Your Patients: GILOTRIF My Guide

This is a guide about taking GILOTRIF. My Guide walks through how GILOTRIF works and what patients can expect while taking GILOTRIF.
 Download GILOTRIF My Guide

 

Are you from a Dispensing Account?

 

GILOTRIF Patient Support Kits

  • Approved Dispensing Pharmacies can place an order for a GILOTRIF Patient Support Kit (PC-US-102908) for patients and providers by e-mailing bipiadmins@archway.com (maximum 3 kits per month)

 

Boehringer Ingelheim cares foundation patient assistance program logo

Boehringer Ingelheim cares foundation patient assistance program

For: Eligible patients who are uninsured or underinsured

The BI Cares Patient Assistance Program is a charitable program provided by the Boehringer Ingelheim Cares Foundation, an independent nonprofit organization. The program helps those in need obtain Boehringer Ingelheim medications including Gilotrif free of charge. Patients prescribed Gilotrif who apply must meet program eligibility requirements including income and prescription coverage criteria in order to be enrolled. The program requires a completed application form signed by patient and healthcare provider and supporting documentation.

Visit the BI Cares Website

Indications and usage

  • GILOTRIF (afatinib) tablets is indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have non-resistant epidermal growth factor receptor (EGFR) mutations as detected by an FDA-approved test.

    Limitation of Use: Safety and efficacy of GILOTRIF have not been established in patients whose tumors have resistant EGFR mutations.

  • GILOTRIF is indicated for the treatment of patients with metastatic squamous NSCLC progressing after platinum-based chemotherapy.