Myfembree

Indicated For

Moderate to severe pain associated with endometriosis

About This Medication

# 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: | Eligibility Factor | Details | Eligible? | |--------------------|---------|-----------| | **Commercial Insurance** | Private plans (e.g., employer, marketplace) | **Yes** [1][2] | | **Medicare/Medicaid** | Government programs | **No** [1][3] | | **Uninsured/Cash-Pay** | No insurance or paying full price | **No** [1] | | **Age** | 18 years or older | **Yes** [1] | | **U.S. Residency** | U.S., Puerto Rico, territories | **Yes** [1] | | **Income** | Any level | **Yes** (no limits) [1] | **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](https://portal.trialcard.com/myovant/myfembree/copay/) 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)

Program information last verified: March 30, 2026