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.

*Some states may require a separate prescription.

 

Highlights within GILOTRIF Patient Services include:

 

Co-pay Assistance Program

  • Maximum out-of-pocket cost could be as little as $0 per month (subject to a maximum monthly benefit of $5,500 and a maximum annual program benefit of $25,000) for commercially insured US-resident patients
  • No income eligibility or additional paperwork required

†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? See the resources below

 

Dispensing Pharmacies Guide

Use this helpful GILOTRIF Patient Services overview guide to find out how the program works and all the resources available for you and your patients.
 Download Dispensing Pharmacies Guide

 

 

Solutions Plus® Enrollment Form

Use this form to enroll your patients to receive support from Solutions Plus®.
 Download Solutions Plus® Enrollment Form

 

 

Dispensing Pharmacy Dose Exchange Form

Use this form to facilitate dose adjustments for your patients. For non‑dispensing accounts, a Dose Exchange form is not needed. For support, please contact an Accredo® representative Monday–Friday from 8am‑8pm EST by calling 1‑844‑569‑2836.
 Dispensing Pharmacy Dose Exchange Form

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.