TAKHZYRO Quick Start PROGRAM
Takeda will provide eligible patients with immediate access to TAKHZYRO at no cost during potential delays in commercial insurance coverage determinations*
To enroll your patients in the Quick Start Program, a commercial insurance investigation must be initiated by filling out the TAKHZYRO Start Form.
This program is available to all patients who meet the following criteria:
≥12 years old
with confirmed
diagnosis of HAE
Received a prescription
for TAKHZYRO
Commercially
insured in the US
*Timing is dependent upon when the forms are received by OnePath®.
Takeda and its affiliates reserve the right to change or discontinue this program at any time, without notice. Void where prohibited by law. This program does not constitute a financial assistance program.
3 simple steps to get your patients started right away
1
Print and fill out these 2 FORMS completely:
2
Fax BOTH forms to OnePath® at
1-855-ONEPATH (1-855-663-7284)
3
Let OnePath take it from there
Once BOTH forms are received by OnePath:
Your patient’s dedicated Patient Support Manager will call your patient promptly to:
- Confirm all forms are complete
- Coordinate shipment of TAKHZYRO
The benefits investigation will be conducted. Prior authorization/appeal, if required, will begin.
A 1-month supply of TAKHZYRO will be shipped to your patient once eligibility requirements have been confirmed and the specialty pharmacy verifies the prescription with your office.† At this time, a specially trained nurse will call the patient to schedule self-administration training.
Once your patient's commercial insurance coverage for TAKHZYRO is approved, he/she will no longer be eligible for the Quick Start Program.
†Once eligibility has been confirmed, a 1-month supply of TAKHZYRO will be shipped to your patients. Patients are eligible for up to 2 months of product at no cost, with the potential for an approval process for continued supply of the product after the second month.
Note that insurance companies sometimes require additional documentation to authorize coverage for TAKHZYRO, which could include:
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