Log me out of my Sancuso session and bring me to the patient Rx solutions landing page

Welcome

Welcome to Patient Rx Solutions

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.

Fax
Complete and fax the SANCUSO
Benefit Verification Form
Fax the form to Patient Rx Solutions at 844-214-3444

*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.