UPLIZNA

Indicated For

Neuromyelitis optica spectrum disorder (NMOSD), Immunoglobulin G4-related disease (IgG4-RD), Generalized myasthenia gravis (gMG)

About This Medication

# Amgen By Your Side Guide: Getting UPLIZNA at Low Cost ## About This Program Amgen By Your Side is a commercial co-pay assistance program designed to help eligible patients afford UPLIZNA (inebilizumab-cdon), a prescription medication used to treat neuromyelitis optica spectrum disorder (NMOSD), immunoglobulin G4-related disease (IgG4-RD), and generalized myasthenia gravis (gMG). This guide explains how to apply and what to expect. ## Am I Eligible? ### Basic Requirements You must meet ALL of these criteria: - Be 18 years or older - Be a U.S. resident or Puerto Rico resident - Have commercial insurance (not Medicare or Medicaid) - Have a valid prescription for UPLIZNA from your healthcare provider ### Income Limits Income limits vary based on household size and change annually. The program uses federal poverty guidelines plus a percentage threshold. Contact Amgen By Your Side directly or visit their website to confirm your specific income limit, as it adjusts yearly. **Note:** If your income exceeds the limit, you may still qualify for other Amgen assistance programs. Ask your healthcare provider or the program representative about alternatives. ### Special Requirement for NMOSD Patients If you're being treated for NMOSD, you must have AQP4-IgG test results available. This blood test confirms your diagnosis and is required to process your application. ## Insurance Requirements This program works exclusively with **commercial health insurance**. Eligible plans include: - PPO (Preferred Provider Organization) - HMO (Health Maintenance Organization) - POS (Point of Service) - Other commercial plans **Important:** Medicare, Medicaid, TRICARE, and Veterans Affairs coverage do NOT qualify for this program. If you have one of these insurance types, you may be eligible for different Amgen assistance options. ## How to Apply: 4 Simple Steps ### Step 1: Gather Your Documents You'll need: - Patient Enrollment Form (download from upliznahcp.com) - Proof of income (pay stubs, tax return, or benefits statement from the past 30 days) - Proof of residence (utility bill or lease agreement) - Insurance card (front and back) - AQP4-IgG test results (NMOSD patients only) ### Step 2: Complete Your Enrollment Form Download the Patient Enrollment Form from upliznahcp.com. Fill it out completely with your personal, financial, and insurance information. Be accurate—incomplete forms delay approval. ### Step 3: Submit Your Application You can apply through **multiple methods**: - Online at https://www.amgenbyyourside.com/uplizna - By mail (address on the enrollment form) - Through your healthcare provider's office Include all required documents with your submission. ### Step 4: Healthcare Provider Enrollment Your doctor or clinic must also be enrolled in the Amgen By Your Side program. Your healthcare provider can complete their enrollment when submitting your Patient Enrollment Form, or they can enroll separately. ## Timeline and What to Expect After submission: - **Processing:** Allow 5–10 business days for review - **Notification:** You'll receive approval or denial status by mail or email - **Card Delivery:** If approved, your co-pay savings card arrives within 1–2 weeks - **Using Your Card:** Present your card at the pharmacy when filling your UPLIZNA prescription ## Your Benefits ### Co-Pay Assistance Once enrolled, you'll receive a savings card that reduces your out-of-pocket costs. Exact savings depend on your insurance plan and co-pay amount. ### Annual Re-Authorization Your enrollment is valid for **one year**. You'll need to reapply annually to maintain your benefits. Amgen By Your Side will notify you when renewal is needed. ## What If I'm Denied? If your application is denied: 1. Review the denial letter—it explains the reason 2. Verify your income still qualifies; re-apply if circumstances changed 3. Ask your healthcare provider about other Amgen patient assistance programs 4. Contact Amgen By Your Side to discuss alternative options ## Need Help? Visit https://www.amgenbyyourside.com/uplizna for more information, downloadable forms, and to apply online. Have questions? Your healthcare provider can also help navigate the program and submit your application on your behalf.

Program information last verified: March 25, 2026