GIVLAARI

Indicated For

Acute Hepatic Porphyria (AHP)

About This Medication

# Alnylam Assist® Patient Assistance Program: How to Get GIVLAARI at Low or No Cost ## About GIVLAARI (Givosiran) GIVLAARI (givosiran) is a prescription medication used to treat acute intermittent porphyria (AIP). This medication helps reduce the frequency and severity of attacks associated with this rare genetic disorder. Because GIVLAARI is a specialized treatment for a rare condition, it can be expensive. The Alnylam Assist® Patient Assistance Program (PAP) is designed to help eligible patients access this medication at no cost. ## Who Qualifies for the Alnylam Assist® PAP To qualify for the Alnylam Assist® Patient Assistance Program, you must meet the following criteria[6]: - **Insurance Status**: You must be uninsured or functionally uninsured (meaning you have insurance that does not cover GIVLAARI) - **Diagnosis**: You must have an on-label diagnosis for GIVLAARI (acute intermittent porphyria) - **Citizenship**: You must be a U.S. citizen or legal permanent resident - **Financial Need**: You must meet specified financial eligibility requirements and provide supporting income documentation If you have commercial insurance that covers GIVLAARI, you may be eligible for the separate Commercial Copay Program instead, which helps cover out-of-pocket costs[6]. ## Income Eligibility The Alnylam Assist® PAP uses financial eligibility requirements to determine qualification. While specific income thresholds are not publicly listed, the program requires you to provide supporting income documentation to verify your financial need[6]. The program is primarily designed for uninsured or functionally uninsured patients. When you apply, you will need to submit proof of your household income. An Alnylam Case Manager will review your financial information and determine your eligibility based on the program's criteria. ## Insurance Requirements The Alnylam Assist® PAP is available to patients who are: - **Uninsured**: You have no health insurance coverage - **Functionally Uninsured**: You have health insurance, but it does not cover GIVLAARI **Important Note**: If you have Medicare, Medicaid, or other government insurance, you may not be eligible for the PAP. However, Alnylam Assist® can help you navigate your government insurance benefits and may offer other support services[2][4]. If you have commercial insurance that covers GIVLAARI, you should explore the Commercial Copay Program, which can help reduce your out-of-pocket costs[6]. ## How to Apply: Step-by-Step ### Step 1: Work with Your Doctor After your doctor prescribes GIVLAARI, you and your doctor will need to complete the Alnylam Assist® Start Form together[3][6]. This form initiates your enrollment in the program and begins the process of verifying your benefits and assessing your eligibility for financial assistance. ### Step 2: Complete the Start Form You have three options for completing the Start Form[6]: - **Online**: Visit www.AlnylamAssist.com and complete the electronic Start Form - **DocuSign**: Request the form via email and complete it electronically through DocuSign - **Fax**: Print the form, complete it with your doctor, and fax it to 1-833-256-2747 Make sure both you and your prescriber sign and date the form before submitting it. ### Step 3: Submit Required Documentation When you submit your Start Form, you will need to provide[6]: - **Proof of Income**: Recent pay stubs, tax returns, or other documentation showing your household income - **Proof of Residency/Citizenship**: A government-issued ID or other documentation proving you are a U.S. citizen or legal permanent resident - **Prescription**: Your GIVLAARI prescription from your doctor - **Completed Start Form**: Signed by both you and your prescriber ### Step 4: Speak with an Alnylam Case Manager Within 2 business days of submitting your Start Form, an Alnylam Case Manager will contact you and your doctor[3][6]. During this call, the Case Manager will: - Review your insurance benefits and explain your coverage - Discuss your financial assistance eligibility - Answer any questions about GIVLAARI or the program - Help you understand next steps ### Step 5: Receive Approval and Start Treatment Once you are approved, Alnylam Assist® will help coordinate the delivery of your medication. Your GIVLAARI will be shipped to you or your physician's office, depending on your preference and treatment plan[6]. ## Timeline and What to Expect **Benefit Verification**: Within 2 business days of submitting your Start Form, you will receive a benefit verification summary from an Alnylam Case Manager[3][6]. **Financial Assistance Assessment**: The Case Manager will also assess your eligibility for financial assistance during this initial contact. **Medication Delivery**: Once you are approved and deemed "order ready," your GIVLAARI will be shipped to your designated location[6]. **Ongoing Support**: Alnylam Assist® provides continuous support throughout your treatment, including disease education, insurance navigation, and assistance with reauthorization when needed. ## Reauthorization Your enrollment in the Alnylam Assist® PAP requires periodic reauthorization. This means you may need to resubmit documentation or recertify your eligibility at certain intervals. Your Alnylam Case Manager will inform you when reauthorization is needed and guide you through the process. ## What If Your Application Is Denied? If your application for the PAP is denied, you have several options: 1. **Ask Why**: Contact your Alnylam Case Manager to understand the specific reason for denial. You may be able to provide additional documentation or clarification. 2. **Explore Other Programs**: You may be eligible for the Commercial Copay Program if you have commercial insurance, or Alnylam Assist® can help you navigate other assistance options. 3. **Appeal**: Ask your Case Manager about the appeals process if you believe there was an error in the determination. 4. **Contact Support**: Call 1-833-256-2748 to speak with an Alnylam representative about alternative options. ## Contact Information - **Phone**: 1-833-256-2748 (general support) or 1-833-831-2065 (application phone) - **Fax**: 1-833-256-2747 (to submit Start Form) - **Website**: www.AlnylamAssist.com ## Important Disclaimer This guide provides general information about the Alnylam Assist® Patient Assistance Program. Eligibility requirements, program terms, and available assistance may change at any time. Alnylam reserves the right to make eligibility determinations and to modify or discontinue any program. For the most current and complete information, visit www.AlnylamAssist.com or contact Alnylam Assist® directly. This information is not a guarantee of eligibility or assistance.

Program information last verified: March 29, 2026