Getting patients started

Start

FOR COMMERCIALLY INSURED PATIENTS

Start your patients through Taltz Together™ or a participating specialty pharmacy and…

THE ENHANCED TALTZ CLEAR ACCESS PROGRAM

^*Shipment can be authorized within 2 business days of submitting a prescription to either a participating specialty pharmacy or Taltz Together and commercial insurance is verified; patient enrolls in the Taltz Savings Card program and schedules shipment.

^†Contingent upon a patient scheduling a delivery with a specialty pharmacy.

^‡Terms and Conditions: Offer good for up to 36 months. $5 Monthly offer subject to a monthly cap and a separate maximum annual benefit of $16,000. $25 Monthly offer subject to a monthly and annual cap of wholesale acquisition cost plus usual and customary pharmacy charges. This offer is invalid for patients without commercial insurance coverage or those whose prescription claims are eligible to be reimbursed, in-whole or in-part, by Medicare Part D, Medicaid, TRICARE or any other state or federal program. Offer void where prohibited by law and subject to change or discontinue without notice. Subject to additional terms and conditions, which can be found here.

^§Constitutes that a prior authorization has been submitted.

Accessing Taltz

FOR COMMERCIALLY INSURED PATIENTS

Access Taltz through a specialty pharmacy that is convenient

Choose a specialty pharmacy that fits prescription process needs

^*Government beneficiaries excluded. Terms and conditions apply. See full details above.

Taltz Specialty Pharmacy Network Partners

Enrollment

You can start the enrollment process for your patients using one of the Taltz contracted specialty pharmacies or through Taltz Together™.

Contracted specialty pharmacies

If using a specialty pharmacy, first make sure it is on the list of Taltz contracted specialty pharmacies^*. Many specialty pharmacies offer enrollment forms on their website. Submit the completed specialty pharmacy enrollment form or the Taltz enrollment form to one of the contracted specialty pharmacies. If the preferred specialty pharmacy is not included in the Taltz network, submit the enrollment form to Taltz Together for assistance. If you have questions, your Taltz sales representative will be able to assist you.

^*To access the list of contracted specialty pharmacies in Puerto Rico, please contact your local sales representative.

List of Contracted Specialty Pharmacies

Taltz Together

To submit to Taltz Together, please fax the completed enrollment form to 1-844-344-8108. Taltz Together will connect patients with the appropriate contracted specialty pharmacy. Patients participating in Taltz Together will be able to choose the support services that best suit their individual needs.

Taltz Together Enrollment Form

Save

Download savings card(s)

^*Governmental beneficiaries excluded, subject to terms and conditions.

Support

Taltz Together is here to provide the resources and support your patients need. For assistance, call 1-844-TALTZ-NOW (1-844-825-8966) or enroll your patients in Taltz Together by completing the Taltz Together Enrollment Form.

Offerings include:

Insurance Investigation

Help with preliminary insurance investigation and specialty pharmacy identification
For help with access, review our step-by-step guide to coverage

Injection Training

Free of charge to patients and their families
Patients can choose either in-person or telephone training
Injection training videos available here

Ongoing Support

A personal patient resource to help answer questions or concerns
Help is available Monday-Friday from 8 AM to 10 PM ET

Field Reimbursement Support

The Field Reimbursement Manager is an experienced access professional who can help your patients navigate the complex access and reimbursement environment

The managers are

Knowledgeable: understand Taltz Together services, access challenges, and affordability options
Connected: integrated with the Taltz Together call center and understand the Taltz contracted specialty pharmacy network
Patient Focused: committed to providing information to support patient access to Taltz

Sharps Disposal Support

Allows patients to safely dispose of Taltz devices. Once the container is full, your patients can mail it back and contact Taltz Together to receive another one

Letters

Coverage Authorization Request Letter

Coverage Authorization Appeals Letter

Letter of Medical Necessity

Formulary Except Request Letter

Tiering Exception Request Letter

Terms and Conditions

^*By using the Taltz Savings Card ("Card"), you attest that you meet the eligibility criteria and will comply with the Terms and Conditions described below:

Try Taltz for as little as $5 a month. $5 Monthly offer subject to a monthly cap and a separate maximum annual benefit of $16,000. $25 Monthly offer subject to a monthly and annual cap of wholesale acquisition cost plus usual and customary pharmacy charges. If you meet program eligibility requirements, have commercial insurance, and your insurance provider covers Taltz, you are eligible to pay $5 monthly. If you meet program eligibility requirements, have commercial insurance, and your insurance provider denies coverage for Taltz, you are eligible to pay $25 monthly. To continue to participate in the $25 monthly program, patients who qualify are required to initiate a benefits investigation and request for coverage within 6 months post program initiation, as well as 12 months post program initiation, to verify coverage status and potential eligibility for the $5 monthly program. Card activation for both the $5 and $25 monthly offers is good for up to 36 months from patient qualification into the program. Subject to the terms and conditions of the program, patients may be eligible to re-enroll provided they continue to meet program criteria. Patient is responsible for any applicable taxes, fees, or amounts exceeding monthly or annual caps.

Offer void where prohibited by law. This offer is invalid for patients without commercial drug insurance or those whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DOD, VA, TRICARE/CHAMPUS, or any state patient or pharmaceutical assistance program. If you live in Massachusetts, the Card expires on the earlier of: (i) the expiration date of this card (12/31/2021); (ii) the date an AB-rated generic equivalent for Taltz becomes available; or (iii) December 31, 2019, absent a change in Massachusetts state law. If you live in California, the card expires on the earlier of: (i) the expiration date of this card (12/31/2021) or (ii) the date an FDA approved therapeutically equivalent for Taltz or over the counter product with the same active ingredients becomes available. Available only in the US and Puerto Rico for residents of the US and Puerto Rico.

By accepting this offer, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you should notify your insurance carrier of your redemption of this Card. This offer is not valid with any other program, discount, incentive, or similar offer involving Taltz. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase or trade; or to counterfeit this Card. This offer may be terminated, rescinded, revoked or amended by Lilly USA, LLC, at any time without notice. This Card is not health insurance. This Card expires on 12/31/2022. Patients must first use their card by 12/31/2019 and are eligible for savings for up to 36 months of therapy.

Ask Lilly your questions!
We’re here to help.

Getting patients started

Start

FOR COMMERCIALLY INSURED PATIENTS

THE ENHANCED TALTZ CLEAR ACCESS PROGRAM

Accessing Taltz

FOR COMMERCIALLY INSURED PATIENTS

Choose a specialty pharmacy that fits prescription process needs

Enrollment

Contracted specialty pharmacies

Taltz Together

Save

Assuring access so your patients^* can confidently get Taltz

Support

Offerings include:

Insurance Investigation

Injection Training

Ongoing Support

Field Reimbursement Support

Sharps Disposal Support

Letters

Indications

Important Safety Information

Getting patients started

Start

FOR COMMERCIALLY INSURED PATIENTS

THE ENHANCED TALTZ CLEAR ACCESS PROGRAM

Accessing Taltz

FOR COMMERCIALLY INSURED PATIENTS

Choose a specialty pharmacy that fits prescription process needs

Enrollment

Contracted specialty pharmacies

Taltz Together

Save

Assuring access so your patients* can confidently get Taltz

Support

Offerings include:

Insurance Investigation

Injection Training

Ongoing Support

Field Reimbursement Support

Sharps Disposal Support

Letters

Indications

Important Safety Information

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Terms and Conditions

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Assuring access so your patients^* can confidently get Taltz