Iqirvo

Indicated For

Primary biliary cholangitis

About This Medication

# IPSEN CARES Patient Assistance Program: How to Get Iqirvo at Low or No Cost ## About This Program The IPSEN CARES Patient Assistance Program is designed to help patients access Iqirvo (elafibranor) when cost is a barrier to treatment. Iqirvo is a medication used to treat primary biliary cholangitis (PBC), a chronic liver disease. If you're struggling to afford your prescription, this program may help you get the medication you need. ## About Iqirvo (Elafibranor) Iqirvo is a prescription medication that works by activating specific receptors in the body to help reduce inflammation and slow the progression of primary biliary cholangitis. Your healthcare provider has determined that this medication is appropriate for your condition. The IPSEN CARES program exists to ensure that cost doesn't prevent you from taking the medication your doctor has prescribed. ## Who Qualifies? You may be eligible for IPSEN CARES assistance if you meet these criteria: - You have a valid prescription for Iqirvo from your healthcare provider - You are experiencing financial hardship - You meet the program's financial eligibility criteria - You are uninsured or functionally uninsured (meaning your insurance doesn't adequately cover Iqirvo, leaving you with high out-of-pocket costs) The program is available to U.S. patients. If you're unsure whether you qualify, the IPSEN CARES team can help determine your eligibility during the application process. ## Financial Eligibility While specific income thresholds are not publicly listed, IPSEN CARES evaluates eligibility based on your individual financial situation. The program considers factors such as: - Your household income - Your family size - Your current medical expenses - Your ability to pay for medication If you're concerned about affording Iqirvo, you should apply. The IPSEN CARES team will review your circumstances and determine what assistance you may qualify for. ## Insurance Requirements This program is designed for patients who are: - **Uninsured**: You don't have any health insurance coverage - **Functionally uninsured**: You have insurance, but it doesn't cover Iqirvo or your out-of-pocket costs (copays, coinsurance, or deductibles) are too high If you have insurance that covers Iqirvo with reasonable out-of-pocket costs, you may not qualify for this program. However, IPSEN CARES also offers a separate Copay Assistance Program that may help reduce your copay costs even if you have insurance. ## How to Apply: Step-by-Step ### Step 1: Get the Enrollment Form Your healthcare provider's office will help you access the IPSEN CARES Enrollment Form. This form is available online and can be completed at your provider's office or at home. ### Step 2: Complete Your Section You (or your legal guardian) will need to fill out: - **Patient Information**: Your name, address, date of birth, contact information, and email - **Insurance Information**: Details about your current health insurance (or confirmation that you're uninsured) - **Patient Assistance Program Section**: Information about your financial situation and why you need assistance - **Authorization**: Your signature confirming you've read and understand the program terms Make sure to fill out all sections completely. Missing information can delay your enrollment. ### Step 3: Your Provider Completes Their Section Your healthcare provider will complete the prescriber sections of the form, including: - Confirmation of your diagnosis and that Iqirvo is medically appropriate for you - Details about your prescription - Their signature and attestation ### Step 4: Submit the Form Your provider's office will fax the completed form to IPSEN CARES at **1-855-465-3820**. Make sure all required pages (typically pages 2-7) are included. Note that if you're not seeking Patient Assistance Program support, page 3 can be left blank. ### Step 5: Benefits Verification Once IPSEN CARES receives your completed form, a Patient Access Manager will contact you and your provider, typically within 1 business day. They will: - Verify your insurance coverage (or confirm you're uninsured) - Review your out-of-pocket costs - Discuss your eligibility for assistance - Explain what support you qualify for ## What You'll Need to Provide To complete your application, have the following ready: - **Valid prescription** for Iqirvo from your healthcare provider - **Proof of financial hardship**: This may include recent pay stubs, tax returns, bank statements, or other documentation showing your income and expenses - **Insurance information**: Your insurance card (if you have coverage) or confirmation that you're uninsured - **Contact information**: Phone number and email address where IPSEN CARES can reach you ## Timeline and Medication Delivery Once you're approved: - **Processing**: IPSEN CARES processes eligible claims within 14 business days - **Payment method**: The program pays your provider via ACH transfer or check - **Delivery**: Your medication will be shipped directly to you or your provider's office The exact timeline from approval to receiving your medication may vary depending on your provider's pharmacy arrangements and shipping time. ## What If Your Application Is Denied? If you don't qualify for the Patient Assistance Program, IPSEN CARES may be able to help you in other ways: - **Copay Assistance Program**: If you have insurance, you may qualify for help with copays - **Alternative resources**: The IPSEN CARES team can discuss other patient support options - **Reapplication**: If your financial situation changes, you can reapply If denied, ask the IPSEN CARES team to explain why and what options remain available to you. ## Contact Information For questions about the IPSEN CARES program or to get started: - **Phone**: 1-866-435-5677 - **Hours**: 8:00 AM to 8:00 PM ET, Monday through Friday - **Website**: www.ipsencares.com The IPSEN CARES team can answer questions about eligibility, help you understand the application process, and discuss what assistance you may qualify for. ## Important Disclaimer This guide provides general information about the IPSEN CARES Patient Assistance Program. Program details, eligibility requirements, and benefits may change. For the most current and complete information, contact IPSEN CARES directly or visit their website. This program is not insurance and does not replace your healthcare provider's medical advice. Always follow your provider's instructions regarding your medication and treatment plan.

Program information last verified: March 30, 2026