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Submit your patient's Sancuso prescription information to have support for benefit verification and prior authorizations. You can also have your Kyowa Kirin products shipped directly to your patient's home.
get your benefit verification started!Complete a one page form by logging into your secure account or send the form via fax.
Sancuso®Patch Price Guarantee
Guarantee Your Commercially Insured Patients at Least 1 Sancuso Patch per Month for $20*. For more details:
*After the patient pays the initial $20, Kyowa Kirin will pay for up to 4 patches per month in the amount of $568.39 and a yearly maximum benefit of $3,288. This offer is not valid for prescriptions under Medicare (including Medicare Advantage, Part A, B and D Plans), Medicaid, VA, DOD, TRICARE, CHAMPUS, or other federal or state healthcare programs. This offer is not valid for prescriptions in Massachusetts or in any other state that does not permit copay reimbursement consistent with this program. Patients without commercial insurance are not eligible for this program. Unless otherwise indicated on submission form, Sancuso will be dispensed through select ASPN network pharmacy partners; available at participating pharmacies. Kyowa Kirin, Inc., reserves the right to cancel or modify the program at any time. Kyowa Kirin reserves the right to change, rescind, revoke, or discontinue this offer at any time without notice.
Copay cards can save your patients money on their SANCUSO prescriptions.
Our team will help eligible uninsured patients explore coverage options for SANCUSO.
The SANCUSO Patch Replacement Program may be able to help patients get replacement patches if they meet program requirements.
When you want to know more about SANCUSO, download the Medical Information Request form and email KyowaKirin-US @medinfodept.com.
CLICK HERE To download information for the Sancuso Patch Price Guarantee
CLICK HERE To download theLetter of Medical Necessity template
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The prescriber will be validated until 5/27/2023 2:55:14 PM