Teva-Support

Prescription and Service Request Form

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Acquiring CINQAIR® Administering CINQAIR® Supporting Patients FAQs Resources

Supporting Patients

  • Teva Support Solutions® offers access and affordability support for patients prescribed CINQAIR® (reslizumab) Injection.
  • A Case Administrator is ready to help with benefits verification, prior authorization support, and information about financial assistance programs for eligible patients. Nurses are available by phone with information and answers to patients’ questions about treatment with CINQAIR®.
  • A Clinical Nurse Educator may be able to help with support and education. Contact Teva Support Solutions® to find out Contact Teva Support Solutions® to find out more.
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Affordability Support

Financial Assistance for CINQAIR®

The CINQAIR® Cost Support Program

The CINQAIR® Cost Support Program helps eligible, commercially insured individuals pay out-of-pocket medication and administration costs, including co-insurance, co-pays, and deductibles.

Eligible patients are automatically enrolled when you submit a Prescription and Service Request Form. Teva Support Solutions® will call your patient to confirm enrollment and send a CINQAIR® Cost Support Program Card to use with their treatment provider to pay the out-of-pocket costs for treatment with CINQAIR®, if eligible.

*The CINQAIR® Cost Support Program helps commercially insured individuals in the United States (including the United States territories) who are prescribed CINQAIR® pay for their eligible out-of-pocket costs for the drug and for administration of the drug, including co-pays, co-insurance, and deductibles. The Program does not cover the costs of physician office visits or evaluations, blood work or other testing, or transportation. Persons residing in the states of Massachusetts, Minnesota, Michigan, and Rhode Island are eligible for financial assistance with their out-of-pocket costs for the drug only and are NOT eligible for other types of financial assistance (administration of the drug). See complete Terms and Conditions. Eligible individuals must have commercial insurance for CINQAIR®. Uninsured and cash-paying patients are NOT eligible for this Program, nor are individuals with commercial insurance coverage that does not provide coverage for CINQAIR®

How Patients Use the Cost Support Program Card

Eligible patients use the Cost Support Program Card to help pay out-of-pocket costs for treatment with CINQAIR® at their infusion treatment provider.

Here’s how the CINQAIR® Cost Support Program works:

  1. Submit claim

    A claim is submitted to the patient’s insurance plan after each infusion.

  2. Receive EOB

    The treatment provider and patient will receive an Explanation of Benefits (EOB) statement from the patient’s insurance plan (this may take several weeks).

  3. Submit EOB

    The EOB will then be submitted by the patient or provider, but not both, to the CINQAIR® Cost Support Program. No other forms are needed.

  4. Issue funds

    The CINQAIR® Cost Support Program will review the EOB, and issue funds to the patient’s Program Card, if eligible. The patient will be notified when this occurs.

  5. Pay out-of-pocket costs

    Once funds are on the patient’s Program Card, they can use it to pay their out-of-pocket costs at their treatment provider.

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Patients use the CINQAIR® Cost Support Program Card to pay out-of-pocket costs for treatment with CINQAIR®.

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For a step-by-step guide, check out the CINQAIR® Cost Support Program Brochures

Download HCP Brochure Download Patient Brochure

Patients with government insurance (Medicare, Medicaid, TRICARE) or patients who are uninsured or underinsured

  • Foundation support may be available for patients with government-funded insurance, or who are uninsured or underinsured who need help affording their medication. Patients can call Teva Support Solutions® to get connected to alternative funding options.
  • For information about additional assistance, visit the Teva Cares Foundation at www.tevacares.org.

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