Trogarzo

Indicated For

multidrug resistant HIV-1 infection, heavily treatment-experienced HIV

About This Medication

# THERA Patient Assistance Program Patient Guide: How to Get Trogarzo at Low or No Cost ## About Trogarzo (Ibalizumab-uiyk) Trogarzo is a prescription HIV medication used to treat multidrug-resistant HIV in patients who have failed other antiretroviral therapies. It is administered as a bi-weekly infusion and is typically used in combination with other antiretroviral drugs. The THERA Patient Assistance Program helps eligible patients access this medication at reduced or no cost. ## Who Qualifies for This Program The THERA Patient Assistance Program offers financial assistance through multiple pathways depending on your insurance status: **Patient Assistance Program (Free Medication):** Uninsured or underinsured patients who meet income and residency requirements may receive Trogarzo at no cost. **Co-Pay Assistance Program:** Patients with commercial or private insurance may qualify for help reducing their out-of-pocket costs. **Government Insurance Support:** Patients with Medicare, Medicaid, or other government insurance can receive information and resources to lower their costs. ## Income Eligibility The program uses a needs-based assessment rather than strict income cutoffs. To qualify for the free medication program, you must demonstrate financial need. The program evaluates your household income and size to determine eligibility. | Category | Requirement | |----------|-------------| | Residency | Must be a legal U.S. resident or Puerto Rico resident | | Insurance | Cannot have private or government drug coverage for Trogarzo (for free program) | | Income Documentation | Must provide proof of household income | | Household Size | Program considers total household size in assessment | ## Insurance Requirements **For the Free Medication Program:** You must be uninsured or have no drug coverage specifically for Trogarzo. If you have any private or government insurance that covers Trogarzo, you are not eligible for the free program but may qualify for co-pay assistance or government insurance support. **For the Co-Pay Assistance Program:** You must have active commercial or private insurance. **For Government Insurance:** If you have Medicare, Medicaid, or other state programs, THERA patient support can help you navigate coverage options and reduce your out-of-pocket expenses. ## Step-by-Step Application Process ### Step 1: Enrollment with Your Healthcare Provider Your healthcare provider must complete the TROGARZO Enrollment Form and submit it to Theratechnologies. Ask your doctor's office to enroll you in the THERA patient support program. ### Step 2: Gather Required Documentation Prepare the following documents: - Most recent federal tax return, OR - Other proof of yearly household income (W-2, 1099, unemployment award letter, Social Security statement, disability statement, or pension statement) - If you have no income, obtain a letter from your physician or social worker on company letterhead confirming you have no income - Proof of U.S. residency ### Step 3: Complete the Patient Assistance Program Form Fill out and sign page 2 of the THERA Patient Assistance Program Form. Attach copies of your income documentation. ### Step 4: Submit Your Application Submit your completed form and documentation by: - **Fax:** 1-855-836-3069 - **Mail:** THERA Patient Support Program, ASPN Pharmacies, LLC, 290 West Mount Pleasant Avenue, Building 2, 4th floor, Suite 4210, Livingston, NJ 07039 ### Step 5: Enrollment Confirmation After submission, a THERA Patient Care Coordinator will contact you to confirm your enrollment and assess your coverage options. They will work with your insurance network to determine where you will receive your bi-weekly treatments. ## Timeline and Medication Delivery **Processing Time:** While specific processing timelines are not detailed in program materials, the prior authorization process typically takes up to 24 hours once submitted to insurance management. **Delivery Method:** Once approved, THERA coordinates with specialty pharmacies in your insurance network. Medication can be shipped to your home or your physician's office, depending on your treatment plan. **Ongoing Support:** After you begin therapy, a THERA Nurse Navigator will contact you to provide support throughout your treatment journey, including bi-weekly check-ins to promote medication adherence. ## What Happens If Your Application Is Denied If your application is denied, contact the THERA Patient Care Coordinator at 1-833-238-4372 to understand the reason. Common reasons for denial include: - Having active drug coverage for Trogarzo through insurance - Not meeting residency requirements - Incomplete documentation You may be eligible for alternative assistance programs, such as the co-pay program if you have commercial insurance, or government insurance support options. ## Reauthorization and Refills Reauthorization is required to continue receiving assistance. Your THERA Patient Care Coordinator will work with you to manage ongoing coverage and reauthorization needs. The program provides continuous support to ensure you don't experience gaps in your treatment. ## Contact Information **THERA Patient Support Line:** 1-833-238-4372 (1-833-23-THERA) **Hours:** Monday to Friday, 8:30 AM – 8:00 PM EST **Fax:** 1-855-836-3069 ## Important Disclaimer This guide provides general information about the THERA Patient Assistance Program. Program eligibility, requirements, and benefits may change. For the most current and accurate information, contact THERA patient support directly or visit your healthcare provider. This program is available only to legal residents of the United States and Puerto Rico. Always consult with your healthcare provider about your specific medical situation and treatment options.

Program information last verified: March 30, 2026