BRIUMVI

Indicated For

Relapsing Multiple Sclerosis

About This Medication

# BRIUMVI Patient Assistance Program Patient Guide: How to Get BRIUMVI (ublituximab-xiiy) at Low or No Cost BRIUMVI (ublituximab-xiiy) is a prescription infusion therapy for adults with relapsing forms of multiple sclerosis (RMS), including clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease.[6] The **BRIUMVI Patient Assistance Program** from TG Therapeutics provides the medication **at no cost** to eligible uninsured or underinsured patients who meet specific income limits.[1][3] ## About BRIUMVI and Why Assistance Matters **BRIUMVI** is a targeted anti-CD20 monoclonal antibody given as an intravenous (IV) infusion. It's unique as the only 1-hour, twice-yearly infusion for RMS after the initial doses (450 mg on Day 1, 27 mg on Day 2, then 450 mg at 24 weeks and every 24 weeks).[8][6] Treatment occurs in a healthcare setting, but costs can be high without help—especially for infusions and administration. Multiple sclerosis (MS) affects over 1 million Americans, causing symptoms like fatigue, mobility issues, and vision problems. RMS means relapses with new or worsening symptoms followed by recovery periods. BRIUMVI reduces relapses by targeting B cells involved in MS inflammation.[6] However, high costs can limit access. That's where the Patient Assistance Program steps in, offering **free medication** for those who qualify, easing financial stress so you can focus on your health.[1][3] **Important safety note**: BRIUMVI can cause infusion reactions (e.g., fever, chills, headache in 48% of patients), infections, and other risks. Discuss with your doctor; premedication is used to limit reactions.[6] ## Who Qualifies for the Program? This program is for **uninsured or underinsured** adults (18+) prescribed BRIUMVI for RMS who meet **fixed annual gross household income limits** based on household size.[1][3] It's separate from the Copay Program (for commercial insurance, up to $20,000/year).[1] ### Income Eligibility Breakdown Eligibility uses **gross household income** (before taxes/deductions). Limits are fixed, not Federal Poverty Level (FPL) based. | Household Size | Maximum Annual Gross Income | |----------------|-----------------------------| | 1 | $100,000 | | 2 | $125,000 | | 3 | $150,000 | | 4 | $175,000 | | 5+ | +$25,000 per additional member[3] | **Example**: A family of 5 qualifies if income ≤ $200,000. Provide recent tax returns, pay stubs, or W-2s as proof.[3] ## Insurance Requirements - **Uninsured**: No prescription coverage at all.[1][3] - **Underinsured**: Insurance denies full coverage (e.g., prior authorization fails, high copays unaffordable).[1] **Not eligible**: Those with Medicare, Medicaid, or commercial insurance that covers BRIUMVI fully. Medicare patients should explore Low-Income Subsidy (LIS/Extra Help) or state programs first. If commercial insurance but high copays, use the Copay Program instead ($0 copay up to $20,000/year).[1][3] ## Step-by-Step Application Process 1. **Talk to Your Doctor**: Confirm BRIUMVI is right for you. They complete the **Start Form** (covers prescription, diagnosis, insurance details).[2][7] 2. **Contact BRIUMVI Patient Support**: Call **(833) 274-8684** (Mon-Fri, 8 AM-8 PM ET). Get assigned a **dedicated Case Manager**—your single contact for guidance.[2][7] 3. **Gather Documents**: - Proof of income (tax return, pay stubs). - Proof of residency (utility bill, lease). - Proof of insurance status (denial letter or insurance card showing no coverage). - Signed Start Form from doctor.[Provided data] 4. **Submit Application**: Multiple methods—fax, mail, or electronic via Case Manager. No online portal specified; phone for details.[Provided data][2] 5. **Approval Wait**: Processing time not specified; Case Manager updates you. Once approved, medication ships free.[Provided data] ## Timeline and Delivery - **Processing**: Varies; call for status. Case Manager handles benefits check, prior auth help.[7] - **Delivery**: Ships directly to **your home or doctor's office** at no cost.[Provided data] - **Treatment Schedule**: Starts soon after approval. Infusions: Week 0 (Day 1 & 2), Week 24, then every 24 weeks.[8] **Reauthorization**: Required periodically—submit updated income/insurance proof.[Provided data] ## If Denied or No Alternatives - **Appeal**: Ask Case Manager for reasons and resubmit.[7] - **Other Options**: - **Copay Program** (commercial insurance).[1] - Third-party charities (e.g., PAN Foundation, HealthWell)—independent, contact directly.[1] - No biosimilars available.[Provided data] - **State Programs**: Check for MS-specific aid. ## Benefits of Enrolling in BRIUMVI Patient Support Beyond assistance, get insurance navigation, education, and Case Manager help for smooth infusions.[2][3] ## Disclaimer This guide is for informational purposes based on available program details as of latest info. Eligibility, terms, and income limits can change—**always verify with TG Therapeutics at (833) 274-8684 or your Case Manager**.[1][3] Not medical/financial advice. Consult your healthcare provider for treatment decisions. TG Therapeutics not liable for third-party aid. Program for US residents only. Word count: 942.

Program information last verified: March 30, 2026