Get Dupixent Copay Card Reimbursement

Filing for reimbursement through the Dupixent Copay Card Program can be straightforward if you follow the necessary steps. This guide will provide you with clear, step-by-step instructions to help you complete the reimbursement form effectively.

Follow the steps to successfully complete your Dupixent Copay Card Reimbursement form online.

1. Press the 'Get Form' button to access the Dupixent Copay Card Reimbursement form and open it in your document management platform.
2. Fill out the patient information section completely. This includes your first name, middle initial, last name, full address, phone number, email, date of birth, and gender. Ensure that all details are accurate.
3. In the reimbursement process section, carefully read the instructions and gather the required attachments, including a copy of the DUPIXENT prescription label. This receipt should display the pharmacy's name and address, dosing details, and days' supply.
4. Enter your member ID and group number in the designated boxes, or attach a copy of the front of your copay card as instructed.
5. Review the patient signature section. Provide your printed name and sign to certify that the information provided is accurate to the best of your knowledge, ensuring the product-specific copay or deductible expenses you request were actually incurred.
6. Finally, ensure all fields are completed and attach the necessary documents as stated. You are now ready to submit your reimbursement request via mail or fax to the provided addresses.
7. After submission, keep an eye on your submission status; reimbursements usually take about 7 to 10 business days to process.

Begin your reimbursement process today by completing the Dupixent Copay Card Reimbursement form online.