RAVICTI

Amgen By Your Side Patient Guide: How to Get RAVICTI at Low or No Cost

About This Program

Amgen By Your Side is a patient support program designed to help eligible patients access RAVICTI (glycerol phenylbutyrate) with financial assistance. This program provides co-pay assistance, reimbursement support, and patient assistance for those who qualify. If you've been prescribed RAVICTI, this guide will help you understand how to enroll and access the medication you need.

What is RAVICTI?

RAVICTI (glycerol phenylbutyrate) is a prescription medication used to help manage certain metabolic conditions. Your healthcare provider has determined that this medication is appropriate for your treatment plan. The Amgen By Your Side program exists to ensure that cost is not a barrier to accessing this important therapy.

Who Qualifies for Amgen By Your Side?

The Amgen By Your Side program determines eligibility on a case-by-case basis. While specific income thresholds are not publicly detailed, the program is designed to assist patients who face financial barriers to accessing their medication. Eligibility is evaluated based on your individual circumstances, including:

• Your household income
• Insurance coverage status
• Out-of-pocket costs for RAVICTI
• Other financial factors relevant to your situation

The best way to determine if you qualify is to contact the program directly or speak with your healthcare provider, who can help assess your eligibility.

Insurance Requirements

Amgen By Your Side works with patients who have various insurance situations:

• Commercially Insured Patients: The program can help reduce your out-of-pocket costs through co-pay assistance
• Uninsured or Underinsured Patients: The program may provide medication at no cost or at reduced prices
• Medicare Patients: Contact the program to discuss your specific coverage situation

The program assists with insurance benefits investigation and helps coordinate with your insurance company to maximize coverage. You should have your insurance information available when you contact the program.

How to Apply for Amgen By Your Side

Step 1: Gather Your Information

Before calling, have the following information ready:

• Your full name and date of birth
• Your contact phone number and email address
• Your insurance card (front and back)
• Your healthcare provider's name and contact information
• Your prescription for RAVICTI

Step 2: Contact the Program

Call Amgen By Your Side at (855) 823-7878 to begin the enrollment process. A support representative will:

• Answer your questions about the program
• Assess your eligibility
• Guide you through the application process
• Explain what financial assistance you may receive

Step 3: Complete the Enrollment Process

You may be asked to:

• Provide additional financial or insurance information
• Sign enrollment forms (which may be completed via DocuSign or paper)
• Authorize the program to work with your insurance company

Step 4: Receive Your Support

Once enrolled, you will be paired with a dedicated support partner called a Patient Access Liaison (PAL) or Clinical Nurse Educator (CNE). Your PAL/CNE will:

• Provide nonmedical education about your treatment
• Help you navigate insurance and financial support options
• Assist with appointment-related information
• Connect you with additional patient support services

Timeline and Medication Delivery

While specific processing times are not detailed in program materials, the enrollment process is designed to be completed efficiently so you can begin your treatment. Once approved, RAVICTI will be coordinated for delivery to you or your healthcare provider's office.

Your PAL/CNE will work with you to ensure smooth delivery and will be available to answer questions throughout your treatment.

What If Your Application Is Denied?

If you are not initially approved for the program, you have options:

1. Ask for clarification: Contact the program to understand why you were not approved
2. Explore alternatives: Ask about generic glycerol phenylbutyrate options, which may be more affordable
3. Reapply: Your circumstances may change, making you eligible in the future
4. Speak with your healthcare provider: They may have additional resources or recommendations

Alternatives to RAVICTI

If RAVICTI is not accessible through this program, discuss with your healthcare provider whether generic glycerol phenylbutyrate might be an option. Generic versions are typically more affordable and may be covered by your insurance at a lower cost.

Important Reminders

• Eligibility criteria and program maximums apply — the program has limits on the assistance it can provide
• Your information is confidential — the program protects your personal and financial information
• You must have a valid prescription — RAVICTI is a prescription medication and requires a healthcare provider's order
• Ongoing support is available — your PAL/CNE remains your partner throughout your treatment

Contact Information

Amgen By Your Side

• Phone: (855) 823-7878
• Website: amgenbyyourside.com
• For general Amgen support: amgensupportplus.com

Disclaimer

This guide provides general information about the Amgen By Your Side program for RAVICTI. Program details, eligibility requirements, and benefits are subject to change. For the most current and complete information, contact Amgen By Your Side directly or visit their website. This guide is not a guarantee of eligibility or enrollment. Always consult with your healthcare provider about your treatment options and financial assistance programs.