SYNAGIS® (palivizumab) Access Support & Financial Assistance

SYNAGIS CONNECT^®

SYNAGIS Copay Assistance Program

HOW TO ORDER

SYNAGIS Access

Help your highest-risk RSV patients get SYNAGIS

Getting Started with SYNAGIS
Describes the pathways to get patients started on SYNAGIS
Example Letter of Medical Necessity
Framework that may be useful to document medical necessity when requesting approval for eligible patients
Prior Authorization Reference Guide
Explains the general process for completing prior authorization for eligible patients
Denial and Appeals Reference Guide
Explains information that may be useful in the event a prior authorization request is denied by a health plan, and provides general guidance on the appeal process
Coding Resource
List of useful codes for billing and reimbursement of SYNAGIS for eligible patients

SYNAGIS CONNECT^® is a support program that provides options for patient healthcare coverage and financial assistance information that may be available to help appropriate patients get access to SYNAGIS.*

Enroll now or call

1-833-SYNAGIS (1-833-796-2447) Monday–Friday 8 _AM–8 _PM ET

Parent/Caregiver Consent Form
Authorization to enroll a patient in SYNAGIS CONNECT^®
View form en español
SYNAGIS CONNECT^® Overview
How can SYNAGIS CONNECT^® help provide support
Universal Enrollment and Prescription Form
Provides the required information to prescribe SYNAGIS through a specialty pharmacy and/or enroll a patient in SYNAGIS CONNECT^®

*SYNAGIS CONNECT^® is not a CoverMyMeds LLC program or solution. SYNAGIS CONNECT^® is owned and operated solely by Sobi, Inc.

Eligibility requirements apply: Patient must be a resident of the US or Puerto Rico. Patient must be commercially insured. There are no income requirements to participate in the program. Patient must not be insured by any government, state, or federally funded prescription program, including Medicare, Medicaid, Medigap, VA, DOD, or TRICARE.

SYNAGIS Copay Assistance Program

The SYNAGIS Copay Assistance Program helps eligible patients with commercial insurance manage out-of-pocket costs. Patients may save up to a maximum of $6,000 per calendar year. See terms and conditions.

DISCLAIMER: The SYNAGIS Copay Assistance Program covers only the cost of the medication, not the cost of administration.

Enroll now or call

1-833-SYNAGIS (1-833-796-2447) Monday–Friday 8 _AM–8 _PM ET

SYNAGIS Copay Assistance Program Overview
Outlines how the SYNAGIS Copay Assistance Program can help lower out-of-pocket costs for eligible patients receiving SYNAGIS
View form en español