FYCOMPA

Indicated For

Partial-onset seizures, Primary generalized tonic-clonic seizures, Epilepsy

About This Medication

# FYCOMPA Patient Assistance Program: How to Get Your Medication at Low or No Cost ## About FYCOMPA (Perampanel) FYCOMPA is a prescription medication used to treat two types of seizures: - **Partial-onset seizures** - seizures that start in one area of the brain - **Primary generalized tonic-clonic seizures** - seizures that affect the entire brain The medication works by blocking AMPA receptors in the brain to help reduce seizure activity. Because FYCOMPA can be expensive, Catalyst Pharmaceuticals offers a Patient Assistance Program to help eligible patients access this important medication at little or no cost. ## Who Can Apply? You may qualify for the FYCOMPA Patient Assistance Program if you meet these criteria: **Insurance Status:** - You are **uninsured** or **underinsured** - You do NOT have Medicare, Medicaid, Tricare, VA benefits, or other Federal or State healthcare plans - If you have private insurance, you may still qualify if it doesn't cover FYCOMPA or your out-of-pocket costs are too high **Income Requirements:** Your household income must fall within acceptable limits. Income thresholds vary based on household size. You'll need to provide proof of your income as part of your application. **Important Note:** If you receive benefits from Medicare, Medicaid, Tricare, the VA, or other government healthcare programs, you are not eligible for this patient assistance program. However, other resources may be available to help you. ## What You'll Need to Apply Gather these documents before starting your application: 1. **Completed FYCOMPA Patient Assistance Program Enrollment Form** - available at the program website 2. **Proof of Income** - provide ONE of the following: - Your most recent IRS Form 1040 (tax return) - SSA-1099 (Social Security statement) - W-2 form from your employer - Social Security benefit statement - Unemployment or disability benefit statement - One month of recent paycheck stubs 3. **Insurance Information** - details about your current health insurance or confirmation that you're uninsured 4. **Government-Issued ID** - may be requested (such as a driver's license or state ID) ## Step-by-Step Application Instructions **Step 1: Get the Enrollment Form** Visit the FYCOMPA website or call the program at (888) 392-6674 to request the Patient Assistance Program Enrollment Form. **Step 2: Complete the Form** Fill out all required sections of the enrollment form completely. Include: - Your personal information - Your doctor's information - Your household income details - Your insurance status **Step 3: Gather Supporting Documents** Collect one proof of income document and your insurance information. If requested, have your government-issued ID ready. **Step 4: Submit Your Application** Fax your completed enrollment form and supporting documents to: **Fax: (844) 633-8444** Make sure to include a cover page with your name and contact information. **Step 5: Wait for Approval** The program typically processes applications within 4-8 weeks. You'll be contacted once your application is reviewed. **Step 6: Receive Your Medication** Once approved, your FYCOMPA will be shipped directly to you. You won't need to pick it up at a pharmacy. ## Timeline & What to Expect - **Processing Time:** 4-8 weeks (typical) - **Delivery:** Your medication will be shipped directly to your home - **Annual Reauthorization:** You'll need to reapply once per year to continue receiving assistance - **Contact Number:** (888) 392-6674 for questions during the process ## Other Options to Lower Your FYCOMPA Costs **FYCOMPA Savings Card Program:** Even if you don't qualify for the Patient Assistance Program, you may be eligible for the FYCOMPA Savings Card, which can help reduce your out-of-pocket costs. Learn more at: https://www.fycompa.com/savings-card-program ## What If Your Application Is Denied? If your application is denied, ask the program: - What was the reason for denial? - Can you provide additional documentation? - Are there other assistance programs available? You may be able to reapply with additional information, or the program can direct you to other resources. ## Important Reminders - **Work with Your Doctor:** Make sure your prescribing doctor is aware you're applying for patient assistance. They may need to provide information supporting your application. - **Keep Your Information Current:** If your income or insurance status changes, notify the program immediately. - **Annual Renewal:** Don't wait until your assistance runs out—plan to reapply about 30 days before your current assistance ends. - **Prescription Refills:** Once approved, follow the program's instructions for refills and reorders. ## Questions? For questions about the FYCOMPA Patient Assistance Program, contact: - **Phone:** (888) 392-6674 - **Fax:** (844) 633-8444 - **Website:** https://www.fycompa.com ## Legal Disclaimer This guide is for informational purposes only and should not be considered medical or legal advice. The eligibility requirements, income thresholds, and program details described here are based on current information but may change. For the most current and accurate information about the FYCOMPA Patient Assistance Program, including specific income limits and eligibility requirements, please contact the program directly or visit the official website. Always consult with your healthcare provider about your treatment options and medication access.

Program information last verified: March 25, 2026