Gilenya

Indicated For

relapsing multiple sclerosis

About This Medication

# Novartis Patient Assistance Foundation Patient Guide: How to Get Gilenya at Low or No Cost Gilenya (fingolimod) is a prescription medication used to treat **relapsing forms of multiple sclerosis (MS)** in adults and children 10 years and older. It works by trapping certain immune cells in lymph nodes, reducing their migration to the brain and spinal cord to help prevent MS relapses and delay disability progression. This guide explains how the **Novartis Patient Assistance Foundation (NPAF)** program can provide Gilenya **free of charge** to eligible patients facing financial hardship. ## Who Qualifies for the NPAF Program? The NPAF helps **U.S. residents** (including territories) who meet specific criteria: - **Limited or no prescription insurance coverage** (uninsured or underinsured). - **Household income at or below 400% of the Federal Poverty Level (FPL)**, which varies by household size and the specific medication like Gilenya. - A **valid prescription** from a licensed U.S. healthcare provider for outpatient treatment. - **Proof of residency** in the U.S. Patients with Medicare, Medicaid, or other insurance may qualify if the program coordinates benefits or if coverage is insufficient. Always check eligibility first at www.PAP.Novartis.com, as guidelines can vary by product. ## About Gilenya (Fingolimod) **Gilenya** is an oral capsule taken once daily to manage relapsing-remitting MS (RRMS), active secondary progressive MS (SPMS), and relapsing MS in pediatrics. Common side effects include headache, back pain, high blood pressure, and increased risk of infections or heart issues—first-dose monitoring is required due to potential bradycardia. It's not a cure but significantly reduces annualized relapse rates (by about 50% in trials) and MRI lesion activity. Discuss risks with your doctor, especially if you have heart, eye, or infection history. NPAF covers Gilenya for eligible patients, ensuring access without copay burdens. ## Income Eligibility Breakdown Eligibility hinges on **household income** (as reported on your tax return) not exceeding **400% of the FPL**. Use the first two pages of your most recent **Form 1040 tax return** as proof. If you don't file taxes, contact NPAF at (800) 277-2254. Here's a table of approximate **2026 FPL thresholds** at 400% (based on HHS guidelines; confirm current levels at PAP.Novartis.com as they update annually): | Household Size | Annual Income Limit (400% FPL) | |----------------|-------------------------------| | 1 (Individual) | $60,320 | | 2 (Couple) | $81,760 | | 3 | $103,200 | | 4 | $124,640 | | +1 per member | +$21,440 | **Notes**: Thresholds adjust yearly for inflation and vary slightly by state. Include all household members on your tax return. Exceeding limits disqualifies you. ## Insurance Requirements NPAF is for **uninsured or underinsured** patients. Submit **front/back copies of all insurance cards** (primary, secondary, prescription). If insured: - Provide **Prior Authorization (PA) approval/denial** or appeal outcomes. - Program coordinates with **Medicare Part D** or **Medicaid**—it won't duplicate benefits but fills gaps. - No private/public prescription coverage? You're more likely eligible. Fully insured patients with adequate coverage typically don't qualify. NPAF supplements, not replaces, insurance. ## Step-by-Step Application Process 1. **Check Eligibility**: Visit www.PAP.Novartis.com. Enter household size/income for Gilenya-specific guidelines. 2. **Gather Documents**: - First 2 pages of recent **1040 tax return** (or income proof if no taxes filed). - **Valid Gilenya prescription**. - **Proof of residency** (e.g., utility bill, ID). - **Insurance cards** (front/back) + PA/denial if applicable. 3. **Complete Application**: Download from PAP.Novartis.com. Patient fills personal/income/insurance sections; **doctor completes/signs prescriber section**. 4. **Submit**: - **Fax**: 1-855-817-2711 (from doctor's office if faxing). - **Mail**: Novartis Patient Assistance Foundation, P.O. Box 2529, Columbus, OH 43216 (or variant addresses like Phoenix, AZ—use latest). - Phone support: (800) 277-2254 or (800) 445-3692. 5. **Sign Authorizations**: Patient/guardian signs for info disclosure. **Tip**: Incomplete apps delay/deny—double-check! ## Timeline and Delivery - **Processing**: 2-4 weeks. You'll get a letter (or text if opted in) with status/next steps. - **Approval**: Medication **shipped free** to your home or doctor's office. - **Reauthorization**: **Required annually** or per supply limit—resubmit updated docs. Track via phone; follow up if no response. ## Alternatives if Denied - **Reapply** with complete docs. - **Other Novartis Programs**: Check PAP.Novartis.com for copay cards (insured patients). - **General Resources**: NeedyMeds.org, RxAssist.org, or MS Society support. - **State Programs**: Medicaid expansion or MS-specific aid. - **Manufacturer Copay Savings**: Novartis offers for commercially insured (not NPAF-eligible). - No biosimilars for Gilenya listed. ## Disclaimer This guide is for informational purposes, based on available NPAF details as of 2026. Eligibility/rules change—verify at www.PAP.Novartis.com or call (800) 277-2254. Not medical/financial advice. Consult your doctor/pharmacist. NPAF not liable for errors. Word count: 1028.

Program information last verified: March 30, 2026