Kombiglyze XR

Indicated For

Type 2 Diabetes

About This Medication

# Bristol-Myers Squibb Patient Assistance Foundation Patient Guide: How to Get Kombiglyze XR at Low or No Cost Kombiglyze XR (saxagliptin and metformin HCl extended-release) is a prescription medication used to help control blood sugar levels in adults with type 2 diabetes, when diet and exercise alone are not enough. The **Bristol-Myers Squibb Patient Assistance Foundation (BMSPAF)** offers this drug at no cost to eligible patients who meet specific income and insurance criteria, making it easier for those facing financial hardship to access vital treatment. ## About Kombiglyze XR **Kombiglyze XR** combines two active ingredients: saxagliptin, a DPP-4 inhibitor that helps the body release more insulin after meals, and metformin extended-release, which reduces glucose production in the liver and improves insulin sensitivity. It's taken once daily with a meal to lower the risk of stomach upset. Common side effects include upper respiratory infections, urinary tract infections, and headache. Always follow your doctor's instructions, and report serious issues like pancreatitis symptoms (severe abdominal pain) or allergic reactions immediately. This program helps ensure you don't skip doses due to cost—sticking to your regimen is key to managing diabetes and preventing complications like heart disease or nerve damage.[1][2] ## Who Qualifies for the Program? The BMSPAF is designed for U.S. residents (including Puerto Rico) aged 18 or older who lack prescription coverage and have limited income. Key requirements include: - **Residency**: Must live in the U.S. or Puerto Rico. - **Age**: 18 years or older. - **Prescription**: Valid prescription for Kombiglyze XR from a licensed provider. - **Income**: Household income at or below **250% of the Federal Poverty Level (FPL)**. - **Insurance**: No prescription drug coverage (including private insurance, Medicaid, Medicare Part D without exceptions, VA, or other programs), **or** if on Medicare Part D, out-of-pocket prescription costs must equal at least 3% of annual household income. Meeting these doesn't guarantee approval—applications are reviewed case-by-case.[1][2][4] ## Income Eligibility Breakdown Eligibility hinges on household income not exceeding 250% of the FPL, which adjusts yearly based on household size. Use recent pay stubs, tax returns (W-2, 1099), Social Security statements, or pension docs as proof. Here's a table with 2026 FPL estimates (check HHS.gov for exact figures, as they update annually): | Household Size | 100% FPL | 250% FPL (Max Eligible Income) | |---------------|----------|-------------------------------| | 1 | $15,060 | $37,650 | | 2 | $20,440 | $51,100 | | 3 | $25,820 | $64,550 | | 4 | $31,200 | $78,000 | *Add ~$5,380 per person for larger households at 100% FPL.* If your income is near the limit or you have Medicare Part D, track out-of-pocket drug costs closely.[1][2] ## Insurance Requirements You generally need **no prescription coverage** for any medications—no private insurance, Medicaid, Medicare Part D (unless you've spent 3% of income on copays), VA, military, or state programs. If insured, prove the plan doesn't cover Kombiglyze XR or that costs are unaffordable. List all coverage on the form. BMSPAF verifies this to ensure aid goes to those without alternatives.[1][2][3] ## Step-by-Step Application Process 1. **Get the Form**: Download from the BMSPAF website (bmspaf.org) or call 1-800-736-0003. Your doctor can help.[1][5] 2. **Patient Section (Section I)**: Fill in personal info (name, address, DOB, SSN), household size/income, current meds, insurance details. Sign the patient agreement and consent.[2] 3. **Provider Section (Sections II & III)**: Your doctor completes treatment/prescription info, facility details, and shipping address (usually their office). Attach prescription. They sign too.[2] 4. **Gather Documents**: - Proof of income (tax return, pay stubs, etc.). - Proof of out-of-pocket costs if Medicare Part D. - Pharmacy printout if applicable.[1][2] 5. **Review & Submit**: Double-check for completeness—incomplete apps delay processing. Mail to: Bristol-Myers Squibb Patient Assistance Foundation, PO Box 220769, Charlotte, NC 28222-0769. Or fax: 800-736-1611.[2] 6. **Track Status**: Call 1-800-736-0003 if no response in weeks.[1] It's free to apply—no fees.[2] ## Timeline and Delivery Processing takes a few weeks after receipt. If approved, expect a **90-day supply** shipped to your **doctor's office** (or home in some cases). Approval lasts up to 1 year; Medicare patients reapply every January. You'll get mail notification.[1][3][4] ## Alternatives if Denied or Ineligible - **Appeal**: Contact BMSPAF to discuss reasons and resubmit with more docs. - **Other BMS Programs**: Check BMS Access Support for copay help if insured.[6][7] - **General Resources**: NeedyMeds, RxAssist, or PAN Foundation. State programs or generic metformin/saxagliptin options. - **Manufacturer Savings Cards**: Visit bms.com for insured patients. - **Doctor Samples** or patient assistance via hospitals.[4][6] ## Reauthorization **Reauthorization is required** annually (or every January for Medicare). Reapply before your supply ends to avoid gaps. Notify BMSPAF of income/insurance changes immediately.[1][2][4] ## Disclaimer This guide is for informational purposes based on available program details as of 2026. Eligibility rules, FPL levels, and processes can change—always verify with BMSPAF at 1-800-736-0003 or bmspaf.org. Not medical advice; consult your doctor for treatment. BMSPAF decisions are final. Providing false info may lead to denial or legal issues. Word count: 1028.

Program information last verified: March 25, 2026