Skytrofa

Indicated For

pediatric growth hormone deficiency

About This Medication

# Ascendis Signature Access Program (A·S·A·P) Patient Guide: How to Get Skytrofa at Low or No Cost ## About This Program The **Ascendis Signature Access Program (A·S·A·P)** is a patient support program designed to help eligible patients access **Skytrofa (lonapegsomatropin-tcgd)**, a prescription medication for growth hormone deficiency. Administered by Ascendis Pharma, A·S·A·P provides comprehensive support including insurance verification, financial assistance, medication delivery, and training on how to use your Skytrofa auto-injector. ## About Skytrofa Skytrofa is a once-weekly injectable growth hormone therapy prescribed for eligible patients with growth hormone deficiency. The medication is delivered via an easy-to-use auto-injector that you can administer at home. Your healthcare provider will determine if Skytrofa is the right treatment option for your condition. ## Who Qualifies for A·S·A·P You may be eligible for A·S·A·P if: - Your healthcare provider has prescribed Skytrofa for an approved indication - You are a U.S. resident - You are uninsured or underinsured - You have commercial insurance but need copay assistance - You meet the program's needs-based eligibility requirements The program is designed to help patients regardless of insurance status. **Uninsured patients automatically qualify** for needs-based assistance. If you have commercial insurance, you may still qualify for copay support to reduce your out-of-pocket costs. ## Income Eligibility A·S·A·P uses a **needs-based approach** rather than strict income cutoffs. This means the program evaluates your individual financial situation to determine eligibility and the level of assistance you receive. During the application process, an A·S·A·P representative will discuss your financial circumstances with you confidentially. If you are uninsured, you are automatically considered for the program's assistance. If you have insurance, the program will verify your coverage and determine what copay support or additional assistance you may qualify for. ## Insurance Requirements | Insurance Status | Eligibility | Support Available | |---|---|---| | Uninsured | Automatic qualification | Full medication assistance based on financial need | | Commercially Insured | Eligible | Copay support and reimbursement assistance | | Medicare/Medicaid | Eligible | Program works with your coverage to minimize costs | If you have insurance, A·S·A·P will verify your coverage and benefits on your behalf. The program will also help navigate prior authorization requirements if your insurance plan requires them. ## Step-by-Step Application Process ### Step 1: Get a Prescription Your healthcare provider will write a prescription for Skytrofa and discuss whether this medication is right for you. Your provider will also initiate your enrollment in A·S·A·P. ### Step 2: Complete Required Forms You will need to complete the following documents: - **Statement of Medical Necessity (SMN)** – A prescription enrollment form completed by your provider - **Patient Consent Form** – Your authorization for A·S·A·P to verify insurance and provide assistance - **Insurance Information** – Copies of your insurance cards (front and back) if applicable ### Step 3: Submit Your Application Your healthcare provider's office will submit your enrollment forms to A·S·A·P via: - **Fax:** 1-888-436-0193 - **Phone:** 1-844-442-7236 (1-844-44ASCENDIS) - **Email:** info@ascendissupport.com You can also contact A·S·A·P directly if you have questions about your application. ### Step 4: Insurance Verification Once A·S·A·P receives your application, a representative will verify your insurance coverage (if applicable). You will be assigned a dedicated A·S·A·P representative who becomes your single point of contact throughout the process. Your representative will send a Summary of Benefits to your healthcare provider. ### Step 5: Financial Assistance Determination A·S·A·P will evaluate your eligibility for financial assistance based on your insurance status and financial need. Your representative will discuss any copay support, co-pay programs, or free medication programs you may qualify for. ### Step 6: Receive Training and Medication Once approved, A·S·A·P will: - Schedule one-on-one training on how to use your Skytrofa auto-injector - Arrange for your medication to be shipped directly to your home or your healthcare provider's office - Provide ongoing support and answer questions about your treatment ## Timeline and Delivery While specific processing times are not published, A·S·A·P works to process applications quickly. Insurance verification typically occurs on the same day your application is received. Your A·S·A·P representative will keep you informed of your application status and expected delivery date. Skytrofa is delivered via specialty pharmacy partners: - **Orsini Specialty Pharmacy:** (888) 204-7802 - **PANTHERx Rare Pharmacy:** (888) 379-1821 You may receive a call from one of these pharmacies to confirm shipping details. It's important to answer these calls to avoid delivery delays. ## What Happens If Your Application Is Denied If your application is denied, your A·S·A·P representative will explain the reason and discuss alternative options with you. The program may help you explore: - Appeals of insurance denials - Alternative funding sources - Other patient assistance programs - Payment plans or discounts Your representative will work with you to find a solution. ## Ongoing Support Once you're enrolled in A·S·A·P, your representative provides continuous support including: - Answering questions about your medication - Coordinating refills and deliveries - Helping with insurance issues or prior authorizations - Providing disease management resources - Assisting with any changes to your treatment plan ## Important Information About Your Privacy When you enroll in A·S·A·P, you authorize Ascendis Pharma to use your health information to: - Verify your eligibility for assistance - Process your benefits and reimbursement - Provide training and educational materials - Improve the program and services Your authorization remains in effect for five years unless you revoke it. You can revoke your authorization at any time by contacting A·S·A·P in writing. ## Contact Information **Ascendis Signature Access Program (A·S·A·P)** - **Phone:** 1-844-442-7236 (1-844-44ASCENDIS) - **Fax:** 1-888-436-0193 - **Email:** info@ascendissupport.com - **Mailing Address:** PO Box 1587, Jeffersonville, IN 47131 ## Disclaimer This guide provides general information about the Ascendis Signature Access Program for Skytrofa. Program eligibility, benefits, and requirements may change. For the most current and complete information, contact A·S·A·P directly or visit your healthcare provider. This information is not a guarantee of assistance or approval. Your healthcare provider and A·S·A·P will determine your individual eligibility based on your specific circumstances.

Program information last verified: March 29, 2026