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Sancuso Patientrx
Not actual size Patch is 52 cm2
(approx. 2.5 in x 3 in)

Sancuso® Patch Price Guarantee

Guarantee Your Commercially Insured Patients at Least 
1 Sancuso Patch per Month for $20*

Simple steps to register your patients for Sancuso 
Patch Price Guarantee Program

Sancuso servizio 1

Write Sancuso prescription as medically necessary

Sancuso servizio 2

Submit script and form through the

HUB here.

Sancuso servizio 3

The 
HUB team
 will work with you to obtain the greatest number of prescribed Sancuso patches allowable through patient’s commercial coverage

LEARN MORE
$530

Kyowa Kirin will pay up to $530 per month (after the patient pays the initial $20)

$3180

For up to 4 patches per month and a yearly maximum benefit of $3,180.

PATIENT ONLY PAYS

$20

This ensures that each commercially insured patient has access to at least 1 patch/month for $20.

Learn how much your commercially insured patients can save–Download the Sancuso Patch Price Guarantee Program Brochure

In the event that patient out-of-pocket costs in connection with filling a prescription for more than one patch are in excess of $20 despite the maximum $530 deferral having been applied, Patient Rx Solutions will work with insurers, prescribers, and the patient to provide the patient with access to the maximum number of prescribed patches the patient is eligible to receive for $20 out-of-pocket.

*This offer is not valid for prescriptions under Medicare (including Medicare Advantage, Part A, B and D Plans), Medicaid, VA, DOD, TRICARE, CHAMPUS, or other federal or state healthcare programs. This offer is not valid for prescriptions in Massachusetts or in any other state that does not permit copay reimbursement consistent with this program. Patients without commercial insurance are not eligible for this program. Unless otherwise indicated on submission form, Sancuso will be dispensed through select ASPN network pharmacy partners; available at participating pharmacies. Kyowa Kirin, Inc., reserves the right to cancel or modify the program at any time. Offer expires January 31, 2018.

Kyowa Kirin

©2016 Kyowa Kirin, Inc. All rights reserved.
SAN-171-R1 February 2017

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The information on this site is intended for healthcare professionals in the United States and is not intended for consumers.