Izervay

Indicated For

geographic atrophy secondary to age-related macular degeneration

About This Medication

# Astellas Patient Assistance Program Patient Guide: How to Get Izervay (avacincaptad pegol) at Low or No Cost Izervay (avacincaptad pegol) is an FDA-approved intravitreal injection used to treat geographic atrophy (GA) secondary to age-related macular degeneration (AMD), a leading cause of vision loss in older adults. The **Astellas Patient Assistance Program** offers eligible uninsured or underinsured patients free medication, helping those who meet strict financial and insurance criteria to access this important treatment without high out-of-pocket costs. ## About Izervay and Geographic Atrophy **Izervay** is a complement C5 inhibitor delivered as an injection into the eye by an eye care professional (ECP). It works by slowing the growth of GA lesions, which are areas of retinal cell loss that cause blind spots and vision impairment. Administered monthly for the first three doses, then every other month, Izervay can help preserve vision longer. Clinical trials showed it reduced GA progression by up to 35% compared to sham treatment. Always discuss with your doctor if Izervay is right for you, as it carries risks like eye inflammation or infection. ## Who Qualifies for the Program? This program targets patients facing financial barriers to Izervay. Key requirements include: - **Prescription**: Must be prescribed by a licensed U.S. eye care professional for FDA-approved GA treatment. - **Age and Residency**: 18+ years old, residing in the U.S. or U.S. territories. - **Insurance Status**: Uninsured; insured but no coverage for Izervay after appeals; or Medicare Part B with unaffordable cost-sharing. **Not eligible** if enrolled in federal/state programs (e.g., Medicaid) or self-paying. - **Income**: Gross annual household income ≤ **$150,000**, regardless of household size. ## Income Eligibility Breakdown The program uses a flat income threshold, making it straightforward. Here's a table for clarity: | Household Size | Maximum Gross Annual Income | |----------------|-----------------------------| | Individual | $150,000 | | Couple | $150,000 | | Family of 3 | $150,000 | | Family of 4+ | $150,000 | *Notes*: Income is gross (before taxes/deductions). Provide recent tax returns, pay stubs, or W-2s as proof. No Federal Poverty Level (FPL) percentage applies. ## Insurance Requirements Eligibility hinges on your coverage: - **Uninsured**: Fully eligible if other criteria met. - **Commercial Insurance**: Must exhaust appeals if denied coverage. - **Medicare Part B**: Eligible if you have coverage but copays/deductibles are unaffordable (program determines this). - **Exclusions**: No assistance for federal/state program enrollees (e.g., Medicare Part D, Medicaid) or self-pay patients. Massachusetts residents/treatments have copay limits (product only, no administration fees). Separate from this, IZERVAY My Way offers copay cards for commercial insurance (up to $20,000/year product, $1,500 admin), but that's not the Patient Assistance Program. ## Step-by-Step Application Process Applying is free and involves your doctor. Multiple methods available: 1. **Gather Documents**: - Astellas Patient Assistance Program eligibility form (signed by you and prescriber). - Proof of income (e.g., 2025 tax return, pay stubs covering 3 months). - Proof of residency (utility bill, lease). - Prescriber certification of medical need. 2. **Choose Method**: - **Phone**: Call (888) 256-9929 for guidance. - **Online Portal**: Visit IZERVAY My Way portal to enroll, upload docs. - **Fax/Email**: Download form, fax to 1-833-256-9929 or email Support@IZERVAYMyWay.com. 3. **Submit**: Doctor completes clinical sections; both sign. 4. **Review**: IZERVAY My Way reviews (may contact for more info). Decisions at Astellas' discretion. 5. **Approval Notification**: You'll be notified; medication ships if approved. Start by discussing with your ECP—they can initiate via the portal. ## Timeline and Delivery Processing time varies (not specified; typically weeks). Once approved, enrollment lasts the calendar year (reassessment possible). **Delivery**: Shipped free to your home or doctor's office. **Reauthorization**: Required annually or for continued need—resubmit docs. ## If Denied or Alternatives Common denial reasons: income too high, ineligible insurance, incomplete docs. Appeal by resubmitting with corrections or contact (888) 256-9929. Alternatives: - **IZERVAY My Way Copay Program**: For commercial insurance (not federal programs). - **Other Support**: Benefits investigation, prior auth help via IZERVAY My Way. - **No Biosimilars**: None available for Izervay. - **State Programs**: Check local resources if ineligible. ## Important Disclaimer This guide is for informational purposes only and based on current program details (subject to change). Astellas reserves rights to amend/revoke without notice. Not insurance; max benefits apply. Consult your doctor for medical advice, program for eligibility. Full terms at IZERVAYecp.com. Program not valid where prohibited. (Word count: 942)

Program information last verified: March 30, 2026