Savings are available for eligible patients
Eligible patients may pay as little as $5 for their Myfembree prescription*
*Offer not valid for patients enrolled in Medicare, Medicaid, or other government healthcare programs. With this Copay Program, eligible patients may pay as little as $5 per prescription for up to an 84-day supply of Myfembree. This Copay Program is subject to a calendar year maximum savings of $5,000. After the calendar year maximum savings is reached, patient will be responsible for the remaining out-of-pocket costs for Myfembree.
Eligible patients may pay as little as $5 for their Myfembree prescription*
*Offer not valid for patients enrolled in Medicare, Medicaid, or other government healthcare programs. With this Copay Program, eligible patients may pay as little as $5 per prescription for up to an 84-day supply of Myfembree. This Copay Program is subject to a calendar year maximum savings of $5,000. After the calendar year maximum savings is reached, patient will be responsible for the remaining out-of-pocket costs for Myfembree.ENROLL PATIENTS HERE† Myfembree® Copay Assistance Program Terms, Conditions, and Eligibility Criteria
- To be eligible for the Myfembree Copay Assistance Program (“Copay Program”), patients must have commercial prescription insurance, have a valid prescription for an FDA-approved indication of Myfembree, be 18 years or older, and be a resident of the U.S., Puerto Rico, or U.S. Territories.
- The Copay Program is not valid for patients enrolled in any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state pharmaceutical assistance program. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. Offer is not valid for cash-paying patients.
- The benefit under the Copay Program is offered to, and intended for the sole benefit of, eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either.
- Copay Card cannot be combined with any other external savings, free trial or similar offer for the specified prescription (including any program offered by a third party payer or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations, through arrangements that may be referred to as “accumulator” or “maximizer” programs).
- Third party payers, pharmacy benefit managers, or the agents of either, are prohibited from assisting patients with enrolling in the Copay Program.
- With this Copay Program, eligible patients may pay as little as $5 per prescription for up to an 84-day supply of Myfembree. This Copay Program is subject to a calendar year maximum savings of $5,000. After the calendar year maximum savings is reached, patient will be responsible for the remaining out-of-pocket costs for Myfembree.
- This card is valid for up to 12 prescription fills for a 28-day supply or 4 prescription fills for an 84-day supply.
- The Copay Program is good only in the U.S., Puerto Rico, or U.S. Territories at participating retail pharmacies. This Copay Program is void where prohibited by law and on the date an AB rated generic equivalent for Myfembree becomes available.
- This offer is not health insurance.
- This offer has no cash value and cannot be combined with any other coupon, free trial, discount, prescription savings card, or other similar offer for the specified prescription.
- This offer is not conditioned on any past or future purchase, including refills.
- This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.
- Patient and participating pharmacists agree not to seek reimbursement from any insurer or third party for all, or any part of the benefit received by the patient through this Copay Program.
- Patient and participating pharmacists agree to report the receipt of Copay Program benefits to any insurer or other third party who pays for or reimburses any part of the prescription filled using the Copay Program, as may be required by such insurer or third party.
- Sumitomo Pharma America reserves the right to revoke, rescind, or amend this offer without notice.
- By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
Pharmacy Instructions:
Pharmacist Instructions for a patient with an eligible third-party payer: When you redeem this card, you certify that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government health insurance programs for this prescription.
- Process a Coordination of Benefits (COB/split bill) claim using the patientʼs prescription insurance for the PRIMARY claim. Submit a SECONDARY claim to PDMI using BIN: 610020 (No PCN required). Offer not valid for discount cards, uninsured/cash patients.
- Valid Other Coverage Code required. For any questions regarding processing, please call the Help Desk at 1-833-693-3627. Program managed by Mercalis on behalf of Sumitomo Pharma America, Inc.
INDICATIONS
Myfembree is indicated in premenopausal women for the management of:
- Heavy menstrual bleeding associated with uterine leiomyomas (fibroids)
- Moderate to severe pain associated with endometriosis
Limitations of Use: Use of Myfembree should be limited to 24 months due to the risk of continued bone loss which may not be reversible.
IMPORTANT SAFETY INFORMATION
BOXED WARNING: THROMBOEMBOLIC DISORDERS AND VASCULAR EVENTS
- Estrogen and progestin combination products, including Myfembree, increase the risk of thrombotic or thromboembolic disorders including pulmonary embolism, deep vein thrombosis, stroke and myocardial infarction, especially in women at increased risk for these events.
- Myfembree is contraindicated in women with current or a history of thrombotic or thromboembolic disorders and those at increased risk for these events, including women >35 years of age who smoke or with uncontrolled hypertension.
CONTRAINDICATIONS
Myfembree is contraindicated in women with: high risk of arterial, venous thrombotic, or thromboembolic disorder; pregnancy; known osteoporosis; current or history of breast- or other hormone-sensitive cancers; known hepatic impairment or disease; undiagnosed abnormal uterine bleeding; known hypersensitivity to components of Myfembree.
WARNINGS AND PRECAUTIONS
Thromboembolic Disorders: Discontinue immediately if an arterial or venous thrombotic, cardiovascular, or cerebrovascular event occurs or is suspected; or if there is sudden unexplained partial or complete loss of vision, proptosis, diplopia, papilledema or retinal vascular lesions and evaluate for retinal vein thrombosis. Discontinue ≥4 to 6 weeks before surgery associated with an increased risk of thromboembolism or during prolonged immobilization.
Bone Loss: Myfembree may decrease bone mineral density (BMD) in some patients, which may be greater with longer use and may not be completely reversible. Consider the benefits and risks in patients with a history of low trauma fracture or risk factors for osteoporosis or bone loss. Baseline dual-energy X-ray absorptiometry (DXA) is recommended in all women. During treatment, DXA is recommended periodically for heavy menstrual bleeding due to uterine fibroids and annually for moderate to severe endometriosis pain.
Hormone-Sensitive Malignancies: Discontinue Myfembree if a hormone-sensitive malignancy is diagnosed. Breast exams and mammography are recommended. Use of estrogen alone or estrogen plus progestin has resulted in abnormal mammograms requiring further evaluation.
Suicidal Ideation and Mood Disorders (Including Depression): Evaluate patients with a history of suicidal ideation, depression, and mood disorders before starting treatment. Monitor for these symptoms including shortly after initiating treatment. Advise patients to seek medical care for new or worsening depression, anxiety, other mood changes, or suicidal ideation and behavior. Gonadotropin-releasing hormone receptor antagonists, including Myfembree, have been associated with mood disorders (including depression) and suicidal ideation.
Hepatic Impairment and Transaminase Elevations: Due to poor metabolism of steroid hormones, instruct these patients to promptly seek medical care for symptoms/signs of liver injury, e.g., jaundice or right upper abdominal pain. Acute liver test abnormalities may require discontinuing Myfembree until tests return to normal and Myfembree causation is excluded.
Gallbladder Disease or History of Cholestatic Jaundice: Discontinue Myfembree if signs/symptoms of gallbladder disease or jaundice occur. Studies among estrogen users suggest a small increased relative risk of developing gallbladder disease.
Elevated Blood Pressure: In women with well-controlled hypertension, monitor blood pressure and stop Myfembree if it rises significantly.
Change in Menstrual Bleeding Pattern and Reduced Ability to Recognize Pregnancy: Advise women to use non-hormonal contraception during and for one week after discontinuing Myfembree. Avoid use with hormonal contraceptives. Myfembree may delay recognition of pregnancy because it alters menstrual bleeding. Test for pregnancy if suspected and discontinue Myfembree if confirmed.
Risk of Early Pregnancy Loss: Myfembree can cause early pregnancy loss. Exclude pregnancy before initiating and advise women to use non-hormonal contraception.
Uterine Fibroid Prolapse or Expulsion: Advise women with known or suspected submucosal uterine fibroids about the risk of uterine fibroid prolapse or expulsion and instruct them to contact their physician if severe bleeding/cramping occurs.
Alopecia: Alopecia, hair loss, and hair thinning were reported in phase 3 trials in women with heavy menstrual bleeding associated with uterine fibroids with Myfembree. Whether hair loss is reversible is unknown.
Effects on Carbohydrate and Lipid Metabolism: More frequent monitoring in women with prediabetes and diabetes may be necessary. Myfembree may decrease glucose tolerance and increase blood glucose concentrations. Monitor lipid levels and consider discontinuing if hypercholesterolemia or hypertriglyceridemia worsens. In women with pre-existing hypertriglyceridemia, estrogen therapy may increase triglycerides levels leading to pancreatitis. Myfembree is associated with increases in total cholesterol and LDL-C.
Effect on Other Laboratory Results: Patients with hypothyroidism and hypoadrenalism may require higher doses of thyroid hormone or cortisol replacement therapy. Combined estrogen and progestin may raise serum concentrations of binding proteins, which may reduce free thyroid or corticosteroid hormone levels. Estrogen and progestin may also affect the levels of sex hormone-binding globulin and coagulation factors.
Hypersensitivity Reactions: Immediately discontinue Myfembree if a hypersensitivity reaction occurs.
ADVERSE REACTIONS: Most common adverse reactions (incidence ≥3% and greater than placebo) were:
- Heavy menstrual bleeding associated with uterine fibroids: vasomotor symptoms, abnormal uterine bleeding, alopecia, and decreased libido.
- Moderate to severe pain associated with endometriosis: headache, vasomotor symptoms, mood disorders, abnormal uterine bleeding, nausea, toothache, back pain, decreased sexual desire and arousal, arthralgia, fatigue, and dizziness.
These are not all the possible side effects.
LACTATION: Advise women not to breastfeed while taking Myfembree.
Please see Important Safety Information throughout and full Prescribing Information, including BOXED WARNING
INDICATIONS
Myfembree is indicated in premenopausal women for the management of:
- Heavy menstrual bleeding associated with uterine leiomyomas (fibroids)
- Moderate to severe pain associated with endometriosis
Limitations of Use: Use of Myfembree should be limited to 24 months due to the risk of continued bone loss which may not be reversible.
IMPORTANT SAFETY INFORMATION
BOXED WARNING: THROMBOEMBOLIC DISORDERS AND VASCULAR EVENTS
- Estrogen and progestin combination products, including Myfembree, increase the risk of thrombotic or thromboembolic disorders including pulmonary embolism, deep vein thrombosis, stroke and myocardial infarction, especially in women at increased risk for these events.
- Myfembree is contraindicated in women with current or a history of thrombotic or thromboembolic disorders and those at increased risk for these events, including women >35 years of age who smoke or with uncontrolled hypertension.
CONTRAINDICATIONS
Myfembree is contraindicated in women with: high risk of arterial, venous thrombotic, or thromboembolic disorder; pregnancy; known osteoporosis; current or history of breast- or other hormone-sensitive cancers; known hepatic impairment or disease; undiagnosed abnormal uterine bleeding; known hypersensitivity to components of Myfembree.
WARNINGS AND PRECAUTIONS
Thromboembolic Disorders: Discontinue immediately if an arterial or venous thrombotic, cardiovascular, or cerebrovascular event occurs or is suspected; or if there is sudden unexplained partial or complete loss of vision, proptosis, diplopia, papilledema or retinal vascular lesions and evaluate for retinal vein thrombosis. Discontinue ≥4 to 6 weeks before surgery associated with an increased risk of thromboembolism or during prolonged immobilization.
Bone Loss: Myfembree may decrease bone mineral density (BMD) in some patients, which may be greater with longer use and may not be completely reversible. Consider the benefits and risks in patients with a history of low trauma fracture or risk factors for osteoporosis or bone loss. Baseline dual-energy X-ray absorptiometry (DXA) is recommended in all women. During treatment, DXA is recommended periodically for heavy menstrual bleeding due to uterine fibroids and annually for moderate to severe endometriosis pain.
Hormone-Sensitive Malignancies: Discontinue Myfembree if a hormone-sensitive malignancy is diagnosed. Breast exams and mammography are recommended. Use of estrogen alone or estrogen plus progestin has resulted in abnormal mammograms requiring further evaluation.
Suicidal Ideation and Mood Disorders (Including Depression): Evaluate patients with a history of suicidal ideation, depression, and mood disorders before starting treatment. Monitor for these symptoms including shortly after initiating treatment. Advise patients to seek medical care for new or worsening depression, anxiety, other mood changes, or suicidal ideation and behavior. Gonadotropin-releasing hormone receptor antagonists, including Myfembree, have been associated with mood disorders (including depression) and suicidal ideation.
Hepatic Impairment and Transaminase Elevations: Due to poor metabolism of steroid hormones, instruct these patients to promptly seek medical care for symptoms/signs of liver injury, e.g., jaundice or right upper abdominal pain. Acute liver test abnormalities may require discontinuing Myfembree until tests return to normal and Myfembree causation is excluded.
Gallbladder Disease or History of Cholestatic Jaundice: Discontinue Myfembree if signs/symptoms of gallbladder disease or jaundice occur. Studies among estrogen users suggest a small increased relative risk of developing gallbladder disease.
Elevated Blood Pressure: In women with well-controlled hypertension, monitor blood pressure and stop Myfembree if it rises significantly.
Change in Menstrual Bleeding Pattern and Reduced Ability to Recognize Pregnancy: Advise women to use non-hormonal contraception during and for one week after discontinuing Myfembree. Avoid use with hormonal contraceptives. Myfembree may delay recognition of pregnancy because it alters menstrual bleeding. Test for pregnancy if suspected and discontinue Myfembree if confirmed.
Risk of Early Pregnancy Loss: Myfembree can cause early pregnancy loss. Exclude pregnancy before initiating and advise women to use non-hormonal contraception.
Uterine Fibroid Prolapse or Expulsion: Advise women with known or suspected submucosal uterine fibroids about the risk of uterine fibroid prolapse or expulsion and instruct them to contact their physician if severe bleeding/cramping occurs.
Alopecia: Alopecia, hair loss, and hair thinning were reported in phase 3 trials in women with heavy menstrual bleeding associated with uterine fibroids with Myfembree. Whether hair loss is reversible is unknown.
Effects on Carbohydrate and Lipid Metabolism: More frequent monitoring in women with prediabetes and diabetes may be necessary. Myfembree may decrease glucose tolerance and increase blood glucose concentrations. Monitor lipid levels and consider discontinuing if hypercholesterolemia or hypertriglyceridemia worsens. In women with pre-existing hypertriglyceridemia, estrogen therapy may increase triglycerides levels leading to pancreatitis. Myfembree is associated with increases in total cholesterol and LDL-C.
Effect on Other Laboratory Results: Patients with hypothyroidism and hypoadrenalism may require higher doses of thyroid hormone or cortisol replacement therapy. Combined estrogen and progestin may raise serum concentrations of binding proteins, which may reduce free thyroid or corticosteroid hormone levels. Estrogen and progestin may also affect the levels of sex hormone-binding globulin and coagulation factors.
Hypersensitivity Reactions: Immediately discontinue Myfembree if a hypersensitivity reaction occurs.
ADVERSE REACTIONS: Most common adverse reactions (incidence ≥3% and greater than placebo) were:
- Heavy menstrual bleeding associated with uterine fibroids: vasomotor symptoms, abnormal uterine bleeding, alopecia, and decreased libido.
- Moderate to severe pain associated with endometriosis: headache, vasomotor symptoms, mood disorders, abnormal uterine bleeding, nausea, toothache, back pain, decreased sexual desire and arousal, arthralgia, fatigue, and dizziness.
These are not all the possible side effects.
LACTATION: Advise women not to breastfeed while taking Myfembree.
Please see Important Safety Information throughout and full Prescribing Information, including BOXED WARNING