For more information, call VYLOY Support Solutions:
1-855-272-6609
Monday–Friday, 8:00 AM–8:00 PM ET
Enroll your patients in VYLOY Support Solutions so they have access to the full range of support.c
aThe healthcare provider remains responsible for populating all clinical information.
bInformation and materials provided by VYLOY Support Solutions are to assist providers, but the responsibility to determine coverage, reimbursement, and appropriate coding for a particular patient and/or procedure remains at all times with the provider.
cProgram eligibility criteria, terms, and conditions apply.
You can also enroll your patient via fax by downloading the Patient Enrollment Form and faxing a completed form to 1-855-272-6653.
Once a patient is enrolled, VYLOY Support Solutions will conduct a benefits investigation and assess a patient's eligibility for financial assistance.
dSubject to eligibility. Program terms and conditions
apply. Void where prohibited by law.
eBy enrolling in the VYLOY Copay Assistance Program ("Program"), the patient acknowledges that they currently meet the eligibility criteria and will comply with the following terms and conditions: The Program is for eligible patients with commercial prescription insurance for VYLOY® (zolbetuximab-clzb) and is good for use only with a valid prescription for VYLOY. The Program has an annual maximum copay assistance limit of $25,000 per calendar year. After the annual maximum on copay assistance is reached, patient will be responsible for the remaining monthly out-of-pocket costs for VYLOY. The Program is not valid for patients who are insured by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Patients who move from commercial insurance to federal or state prescription health insurance will no longer be eligible, and agree to notify the Program of any such change. This offer is not valid for cash paying patients. Patients agree not to seek reimbursement from any health insurance or third party for all or any part of the benefit received by the patient through the Program. This offer is not conditioned on any past, present, or future purchase of VYLOY. This offer is not transferrable, has no cash value, and cannot be combined with any other offer, free trial, prescription savings card, or discount. The full value of the Program benefits is intended to pass entirely to the eligible patient. The benefit available under this Program is valid only for the patient's out-of-pocket medication costs for VYLOY. The benefit is not valid for any other out-of-pocket costs such as medication administration charges or other healthcare provider services. No other individual or entity (including, without limitation, third party payers, pharmacy benefit managers, or the agents of either) is entitled to receive any benefit, discount, or other amount in connection with this Program. This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, and Puerto Rico. This Program is void where prohibited by law. No membership fees. Certain rules and restrictions apply. Astellas reserves the right to revoke, rescind, or amend this offer without notice for any reason (including to ensure that the offer is utilized solely for the patient's benefit).
Patient Connect is a program that helps connect patients and caregivers to resources that can provide emotional, logistical, and informational support to assist in managing daily life while being treated with VYLOY.f
Patients and their caregivers can request assistance by calling VYLOY Support Solutions and speaking to a Case Manager.
fSupport is provided through
third-party organizations that operate independently and are not
controlled or endorsed by Astellas. Availability of support and
eligibility requirements are determined by these organizations.
Healthcare providers can obtain VYLOY from the participating specialty pharmacies and specialty distributors listed below.
Please call if you have any questions or need assistance.
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