LIVMARLI

Mirum Patient Assistance Program (PAP) Patient Guide: How to Get LIVMARLI (maralixibat) at Low or No Cost

LIVMARLI (maralixibat) is an oral solution prescribed to help manage cholestatic pruritus (itching) in patients with Alagille syndrome, a rare genetic disorder affecting the liver and other organs. The Mirum Patient Assistance Program (PAP) from Mirum Pharmaceuticals provides LIVMARLI at no cost for up to one calendar year to eligible uninsured patients or those whose insurance coverage has been denied, with eligibility reviewed annually.

About LIVMARLI (maralixibat)

LIVMARLI is a prescription medication that works by inhibiting the bile acid transporter in the gut, reducing bile acid buildup that causes severe itching in conditions like Alagille syndrome. It's taken as an oral solution, typically once daily, and dosing is based on your weight and doctor's instructions. Clinical data shows it can significantly improve itch severity and quality of life for many patients. Always follow your healthcare provider's guidance, as LIVMARLI is part of a broader treatment plan that may include monitoring liver function and other supportive care.

Important Safety Note: LIVMARLI can cause side effects like diarrhea, abdominal pain, and changes in liver tests. Contact your doctor immediately if you experience severe symptoms. This guide focuses on access, not medical advice—discuss benefits and risks with your prescriber.[1][4]

Who Qualifies for the Program?

The Mirum PAP is designed for patients who lack insurance coverage or have been denied by their insurer. Key eligibility criteria include:

• Uninsured patients or those with insurance coverage denied (e.g., after prior authorization or appeal denial).[1]
• U.S. residents (including Puerto Rico for some programs).[7]
• Prescription from a licensed healthcare provider for an FDA-approved use, such as cholestatic pruritus in Alagille syndrome (patients 3 months and older).[1]
• No strict income thresholds listed; eligibility is determined case-by-case by the Mirum Access Plus team, who review applications annually.[1]

The program provides free medication for up to 1 year, after which re-enrollment is required. Approximately 94% of patients get insurance approval overall, but PAP steps in when needed.[4]

Income Eligibility Breakdown

Unlike many programs tied to Federal Poverty Level (FPL), Mirum PAP does not publish fixed income limits. Instead, the Mirum Access Plus team evaluates financial need holistically during review. Here's a general overview:

Notes: FPL figures are estimates for illustration (actual 2026 levels may vary). Mirum prioritizes access over rigid cutoffs—contact them for your situation. Annual review ensures ongoing need.[1]

Insurance Requirements

• Primary Eligibility: Uninsured or insurance denied (e.g., prior authorization rejected, even after appeal).[1][5]
• Not for: Patients with active commercial/private insurance coverage (they may qualify for the Savings Program, paying as little as $10 per fill).[1][4]
• Medicare/Medicaid: Program is for those without coverage; Medicare patients denied coverage may qualify. Mirum Access Plus helps navigate prior authorizations (PAs).[5]
• Coverage Stats: LIVMARLI is covered by 100% of plans (as of 2023 data), but denials happen—PAP provides a safety net.[1]

If insured, explore Mirum Access Plus for PA support, peer-to-peer reviews, or appeals before PAP.[5]

Step-by-Step Application Process

1. Talk to Your Doctor: Confirm LIVMARLI is right for you. Your prescriber completes the Patient Enrollment Form (download from livmarlihcp.com or request via phone).[1][5]
2. Gather Documents:
   • Patient Enrollment Form (HCP and patient sections).[1]
   • Copy of insurance card (front/back) if applicable, or proof of denial.[6]
   • Patient consent for services (e.g., text opt-in for reminders).[6]
3. Submit: Fax to 1-855-282-4884. Your doctor handles most fields; you provide personal/insurance info.[1][3]
4. Mirum Review: Access Plus team assesses eligibility (uninsured/denied) and financials. Opt-in for mobile app/texts to track status.[1]
5. Approval Notification: You'll be contacted; if urgent (e.g., 5+ day delay), request Urgent Access for 15-day supply (up to 60 days).[9]

Phone Support: Call 1-855-MRM-4YOU (1-855-676-4968) Mon-Fri, 8 AM-8 PM ET for help.[1][4]

Timeline and Delivery

• Processing: Varies; urgent cases get 15-day supply quickly. Standard approvals aim for prompt access—track via app/texts.[1][9]
• Delivery: Shipped free to your home via a specialty pharmacy (e.g., for temperature-controlled oral solution).[1]
• Refills: Reauthorization required annually; your doctor resubmits form. Ongoing support via Mirum Access Plus.[1]

Alternatives if Denied or Ineligible

• Mirum Savings Program: $10 copay for commercial insurance.[1]
• Urgent Patient Access: 15-60 day bridge supply during delays.[9]
• QuickStart (similar programs): Temporary supplies for other Mirum meds.[7]
• Appeals: Mirum assists with insurance appeals/peer-to-peers.[5]
• Other Resources: State programs, non-profits like PAN Foundation, or manufacturer copay cards. Reapply to PAP if circumstances change.

Disclaimer

This guide is for informational purposes only and based on publicly available program details as of 2026. Eligibility, terms, and availability can change—always verify with Mirum at 1-855-676-4968. Not medical advice; consult your doctor. Mirum Pharmaceuticals reserves rights to modify/amend the program. Word count: ~950.