Myfembree

Myfembree Support Program / Myfembree Copay Assistance Program Patient Guide: How to Get Myfembree (relugolix, estradiol, and norethindrone acetate) at Low or No Cost

Myfembree Support Program, including the Copay Assistance Program, helps commercially insured patients pay as little as $5 per prescription for Myfembree, up to a $5,000 annual savings limit. This guide explains eligibility, application steps, and more to make accessing treatment easier.[1][2][3]

About Myfembree

Myfembree (relugolix, estradiol, and norethindrone acetate) is a prescription medication for premenopausal women 18 years or older. It treats:

• Heavy menstrual bleeding due to uterine fibroids (leiomyomas).
• Moderate to severe pain associated with endometriosis.[3][6]

Taken as one tablet daily, it should not be used for more than 24 months. It works by reducing hormones that cause symptoms, but discuss with your healthcare provider (HCP) if you have risks like smoking over age 35, liver problems, or mood disorders.[3][6]

Important safety notes: Myfembree has a Boxed Warning for bone loss (may reduce bone density; not for women with known osteoporosis). Watch for suicidal thoughts, mood changes, liver issues, or high blood pressure. Call your HCP immediately for new or worsening symptoms like depression, yellowing skin, or dark urine.[3][6]

Who Qualifies for the Program?

This is a copay assistance program for commercially insured patients only. You must:

• Be 18+ years old and a resident of the U.S., Puerto Rico, or U.S. Territories.[1][2]
• Have a valid prescription for an FDA-approved use of Myfembree.[1]
• Have commercial (private) prescription insurance—not Medicare, Medicaid, cash-pay, uninsured, or other government programs.[1][2][3]

No specific income thresholds apply, making it accessible regardless of earnings as long as you meet insurance rules.[1]

Income Eligibility Breakdown

Unlike free medication programs, this copay program has no income limits. Eligibility focuses on insurance type. Here's a simple table:

Annual cap: Up to $5,000 savings per calendar year. After that, you pay full out-of-pocket costs.[1][3]

Insurance Requirements

Commercial insurance required. Program covers copays, coinsurance, or deductibles for eligible fills (up to 84-day supply).[1][3]

Pharmacies process a primary claim through your insurance, then a secondary claim to the program (BIN: 610020, no PCN needed). Use a valid Other Coverage Code. Not for discount cards.[1]

If your plan requires prior authorization (PA) or step therapy, work with your HCP first—common for Myfembree.[9]

Step-by-Step Application Process

1. Get your prescription: Ensure your HCP prescribes Myfembree for an approved use.[1]

2. Check eligibility: Confirm commercial insurance and meet criteria (age, residency).[1][2]

3. Enroll online: Visit the enrollment portal or myfembree.com/cost-and-support. Get your Myfembree Copay Card digitally.[1][2][9]

4. At the pharmacy: Present your insurance card and Copay Card. Pharmacy submits claims as noted above.[1]

5. Call for help: Dial (833) 693-3627 for questions, processing issues, or support. Program managed by Mercalis (formerly TrialCard) for Sumitomo Pharma America (previously Myovant/Pfizer).[1][4]

Your office staff can assist with enrollment—many provide forms at checkout.[9]

No paper forms or extra documents typically needed for copay enrollment, but have prescription and insurance ready.[1][9]

Timeline and Delivery

• Activation: Instant upon enrollment and first pharmacy use.[1]

• Processing: Pharmacy handles claims on-site; help desk resolves issues quickly.[1]

• Delivery: Medication shipped to patient or picked up at pharmacy—standard prescription fill (up to 84 days).[1]

• Refills: Reauthorization required periodically. Program valid through calendar year or until $5,000 cap.[1]

Expect same-day savings at eligible pharmacies.

Alternatives if Denied or Ineligible

• Denied? Appeal insurance PA/step therapy with HCP documentation (e.g., failed prior treatments).[9]

• Government insurance? Explore state programs or Pfizer RxPathways for other options (Myfembree not free medicine).[4]

• Uninsured? Check nonprofit hubs like RxAssist or patient access foundations—not covered here.[8]

• Biosimilars: None available.[1]

Contact 1-833-MYFEMBREE for personalized guidance.[4]

Reauthorization and Refills

Reauthorization required. Enroll once yearly; track $5,000 cap. Refill with Copay Card each time.[1]

Disclaimer

This guide is for informational purposes based on program details as of latest available info. Not medical or legal advice. Eligibility, terms, and savings can change—verify at enrollment or by calling (833) 693-3627. Consult your HCP for treatment suitability. Program terms at myfembree.com.[1][2][3] Void where prohibited. (Word count: 928)