We offer valuable financial programs to help your patients afford their medication.

Click or scroll to download patient access program resources and review program information.

For more information about AKYNZEO please see the full Prescribing Information.

Helsinn Cares Patient Enrollment Form Helsinn Cares Program Requirement Guide Helsinn Cares Program

Patient Assistance Program Drug Appeals Replacement Program Pay $0 Savings Program Co-pay Card

Your First Step for Patient Enrollment: Complete the PEF today to enroll a patient in the programs below

Helsinn Cares Program Patient Enrollment Form (PEF)

  • Enroll your patients in Helsinn Cares to help them with AKYNZEO® affordability, confirm benefit coverage, and facilitate prior authorizations.
  • Eligibility is determined post-enrollment for patients to be considered for our Patient Assistance Program, which provides AKYNZEO® savings.

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Helsinn Cares Program Requirements Guide

  • Learn about requirements for Helsinn Cares programs, including key forms and steps.
  • The guide covers both Healthcare Provider Payer support programs and Healthcare Provider/Patient support programs, as well as J Code billing requirements.

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Helsinn Cares Program for AKYNZEO® Capsules or Injection

  • Enroll your patients in Helsinn Cares to assist with AKYNZEO® affordability.
  • This program helps confirm benefit coverage and facilitate prior authorizations.
  • Once enrolled, eligible patients will be considered for our Patient Assistance Program, which provides AKYNZEO® savings.

How to enroll

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Patient Assistance Program for AKYNZEO® Capsules or Injection

  • Our Patient Assistance Program is designed for patients who need help paying for AKYNZEO®.
  • Through this program AKYNZEO® is available at no cost to uninsured and underinsured patients, including Medicare Part D beneficiaries who are eligible for this program.

How to enroll:

Eligibility criteria include:

  • Patient is prescribed AKYNZEO®
  • Patient has valid mailing address that is not a P.O. box
  • Patient is a US resident (includes Puerto Rico, Guam, and the US Virgin Islands)
  • Patient is uninsured or underinsured, with no covered AKYNZEO® benefit
  • Patient is insured, but prior authorization and 1 appeal were denied (if applicable)
  • Patient must meet income criteria, and income documentation is required

Important information:

  • Helsinn reserves the right, at its sole discretion, to discontinue the Patient Assistance Program or change the qualifications at any time.
  • Product supply for the program depends upon availability.
  • The enrollment form, insurance information, financial documentation, signature of the prescribing healthcare professional, and patient's signature are required for the form to be considered complete.

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Drug Appeals Replacement Program for AKYNZEO® Injection

If program eligibility is met, Helsinn Cares will provide a replacement vial to a provider's office if the payer has denied on-label usage of AKYNZEO®.

  • After AKYNZEO® for Injection is administered, provider enrolls in Helsinn Cares, provides completed PEF, and Benefit Investigation (BI) on-label payer denial* documentation
  • Prior authorization, if required, has been completed and documentation provided to Helsinn Cares
  • An on-label denial by the payer has been confirmed by Helsinn Cares
  • Appeal completed by the provider and remains in denied (on-label) status, documentation provided
  • Two denials required and confirmed by Helsinn Cares
  • A Helsinn Cares Case Manager will contact ONCO360 to ship replacement vial to the provider address
  • Provider’s AKYNZEO® for Injection buy/bill stock administered is replaced with shipment from ONCO360 through the Appeal Replacement Program

*On-label denial defined through Helsinn Cares

How to enroll:

A Helsinn Cares Case Manager will carefully review your submission documentation and confirm with the payer if a replacement vial would be required.

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Pay $0 Savings Program Co-pay Card for AKYNZEO® Capsules

  • For patients with commercial insurance, enroll in our Pay $0 program to pay a $0 co-pay on each AKYNZEO® prescription, with an annual $1,800 limit.
  • For patients who use cash for their co-pay, Helsinn Cares will pay up to $150 per prescription, with an annual $1,800 limit.

How to enroll:

Eligibility Criteria:

Good toward the purchase of AKYNZEO® prescriptions. No substitutions permitted. Save this card to reuse with each prescription. Not available to patients enrolled in state or federal healthcare programs, including Medicare, Medicaid, Medigap, VA, DoD, or TRICARE. Offer available to MA residents through June 30, 2019. For all other patients, this offer will expire October 3, 2019. May not be combined with any other coupon, discount, prescription savings card, free trial, or other offer. Federal law prohibits the selling, purchasing, trading, or counterfeiting of this card. Such activities may result in imprisonment of 10 years, fines up to 25,000, or both. Void outside the USA and where prohibited by law. Helsinn Therapeutics (U.S.), Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice. Patients and pharmacies are responsible for disclosing to insurance carriers the redemption and value of the card and complying with any other conditions imposed by insurance carriers on third-party payers. The value of this card is not contingent on any prior or future purchases. The card is solely intended to provide savings on any purchase of AKYNZEO® . Use of the card for any one purchase does not obligate the patient to make future purchases of AKYNZEO® or any other product.

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