Zolgensma

Indicated For

Spinal Muscular Atrophy (SMA)

About This Medication

# Novartis Patient Assistance Program Patient Guide: How to Get Zolgensma (onasemnogene abeparvovec-xioi) at Low or No Cost Zolgensma is a groundbreaking **one-time gene therapy** for children under 2 years old with **spinal muscular atrophy (SMA)**, a rare genetic disease that causes muscle weakness and can be life-threatening if untreated. The Novartis Patient Assistance Program (also known as the Novartis Patient Assistance Foundation, or NPAF) helps **qualified patients** get Zolgensma at low or no cost if you meet income and other eligibility rules. This guide explains everything you need to know in simple terms. ## About Zolgensma and Why Assistance Matters **Zolgensma (onasemnogene abeparvovec-xioi)** delivers a functional copy of the SMN1 gene via an intravenous infusion, addressing the root cause of SMA Type 1. It's FDA-approved for infants with a confirmed SMA diagnosis and bi-allelic SMN1 mutations. Treatment is typically given as a single dose before age 2, ideally as early as possible for best outcomes. Without insurance or help, Zolgensma costs over $2 million, making programs like this vital for families.[1][2][4] SMA affects about 1 in 10,000 live births, robbing children of the ability to sit, stand, or breathe independently. Early Zolgensma can enable milestones like sitting unsupported. Always consult your doctor for personalized advice—this guide is for information only. ## Who Qualifies for the Program? The program is for **U.S. residents** (including territories) facing financial hardship. Key requirements: - **Valid prescription** for Zolgensma from a licensed U.S. healthcare provider. - **Outpatient treatment** basis. - **Limited or no prescription insurance** (commercially insured or uninsured qualify if other criteria met; Medicare/Medicaid often ineligible). - **Income eligibility**: Household income must meet guidelines based on **Federal Poverty Level (FPL)** sliding scale (exact % not specified; **contact program** for your household size). Provide proof like tax returns, pay stubs, or bank statements.[1][2][3][4] **Notes**: No set thresholds listed publicly for individuals/couples/families—call (855) 441-4363 or (800) 277-2254 to check. Program ships to **site of administration** (e.g., hospital), not home.[program details] ## Income Eligibility Breakdown Specific FPL percentages aren't fixed publicly and vary by drug/household. Use this table as a guide—**verify with program** as guidelines update. | Household Size | Example Max Income (300% FPL, illustrative)* | Notes | |---------------|---------------------------------------------|-------| | 1 person | ~$45,180 | Sliding scale; attach tax return/pay stubs[2][3] | | 2 people | ~$61,320 | Include all in home[3] | | 3 people | ~$77,460 | Proof required[4] | | 4 people | ~$93,600 | Contact for exact[1] | *Illustrative based on 2023 FPL; actual varies. Call for current Zolgensma thresholds.[2][3] ## Insurance Requirements - **Eligible**: Commercially insured (limited coverage), **uninsured**. Submit front/back of **all** insurance cards.[4][6] - **Ineligible**: Medicare Part D, Medicaid, or other public programs covering prescriptions.[3] - If insured, program may cover copays/costs after insurance denial (include prior auth denials).[3][4] ## Step-by-Step Application Process 1. **Check Eligibility**: Call (855) 441-4363 or visit www.PAP.Novartis.com. Confirm Zolgensma availability.[4] 2. **Gather Documents**: - **Prescription form** (separate Rx faxed by doctor). - **Start form** (patient/doctor sections). - **Patient consent form** (authorize info sharing).[6][8] - **Proof of residency** (e.g., utility bill). - **Proof of income** (tax return first 2 pages, 3 months pay stubs/bank statements).[2][3] - **Insurance info** (cards front/back).[4] 3. **Complete Forms**: Patient fills personal/financial sections; doctor completes prescriber part, signs, adds Rx.[1][3] 4. **Submit**: **Multiple methods**—fax (1-855-817-2711), mail (Novartis Patient Assistance Foundation, PO Box 2529, Columbus, OH 43216 or variant addresses), or call for guidance. Phone: (855) 441-4363 / (800) 277-2254 (M-F, 9am-6pm EST).[2][3][6] 5. **Follow Up**: Expect decision in ~4 weeks. Track via phone.[2] **Tip**: Review checklist—**incomplete apps delay/deny**. Doctor must authorize and prescribe.[3][4] ## Timeline and Delivery - **Processing**: ~4 weeks for decision letter.[2] - **Delivery**: **Shipped to site of administration** (hospital/infusion center), not home. No set timeline post-approval; coordinate with provider.[program details] - **No reauthorization** needed (one-time therapy).[program details] ## Alternatives if Denied - **Appeal**: Submit updated docs or prior auth denials.[3] - **Other Programs**: State assistance, Simplefill (877-386-0206), or manufacturer copay cards (if insured).[5] - **Non-profits**: SMA Foundation, Cure SMA for grants. - **Clinical Trials**: Check ClinicalTrials.gov for Zolgensma access. - Reapply if circumstances change (e.g., income drop).[3] ## Important Disclaimer This guide is for educational purposes and based on available info as of 2026. **Program details change**—**always contact Novartis directly** at (855) 441-4363 for latest eligibility/forms. Not medical/financial advice. Consult your doctor. Novartis may end/change program anytime. Do not send originals; copies only. Eligibility not guaranteed.[1][2][3][4][program details] (Word count: 1028)

Program information last verified: March 25, 2026