Access and Reimbursement
Amgen believes in the importance of access to treatment and may be able to help patients who have concerns about affording IMLYGIC® (talimogene laherparepvec). In this section, you’ll find information about Amgen's access and reimbursement resources, including IMLYGIC® coding and billing information, Amgen Assist 360™, the IMLYGIC FIRST STEP™ Program, and the Amgen Safety Net Foundation. In addition, this section includes information about referrals to charitable independent co-pay foundations* that may help patients afford their prescribed melanoma medicine.
*Provided through independent charitable patient assistance programs; program eligibility is based on the charity's criteria. Amgen has no control over independent, third-party programs and provides referrals as a courtesy only.
IMLYGIC® billing and coding information
Hospital Outpatient - Billing Information Sheet for IMLYGIC®
Physicians Office - Billing Information Sheet for IMLYGIC®
Amgen Assist 360™
Amgen Reimbursement Specialists
Connect with an Amgen Reimbursement Counselor or schedule a visit with a Field Reimbursement Specialist.
Patient Resource Guide
Find co-pay and reimbursement resources† for patients with different kinds of insurance, or no insurance at all.
Submit, store, and retrieve benefit verifications for all your patients currently on an Amgen product.
Amgen Assist 360™ Nurse Ambassadors
An Amgen Assist 360™ Nurse Ambassador is a single point of contact who can help patients and caregivers find the resources that are most important to them, so that they can stay focused on their treatment. Nurse Ambassadors are there to support, not replace, your treatment plan and do not provide medical advice or case management services.‡
Co-pay and reimbursement resources
Help patients with insurance benefit verification and put them in touch with programs that may help them afford their prescribed medication, such as Amgen FIRST STEP™ or other independent nonprofit organizations.†
Help finding transportation and lodging assistance
Refer patients to independent nonprofit organizations that may provide assistance with treatment-related travel costs such as gas, tolls, parking, airfare, and lodging.†
Referrals to resources for day-to-day living
Help patients get in touch with independent nonprofit organizations that may provide community resources, local support groups, and counseling services.†
†Provided through independent nonprofit patient assistance programs; program eligibility is based on the nonprofit’s criteria. Amgen has no control over these programs and provides referrals as a courtesy only.
‡Patients should always consult their healthcare provider regarding medical decisions or treatment concerns.
IMLYGIC FIRST STEP™ for eligible commercially insured patients
The IMLYGIC FIRST STEP™ Program can help eligible commercially insured patients meet their deductible, co-insurance, and co-payment.
- No out-of-pocket cost for the first dose.
- No income eligibility requirement.
- For subsequent doses, Amgen will pay the out-of-pocket amount in excess of $25 per dose, up to $10,000 in assistance per patient per calendar year.
Here’s what patients need to qualify§:
- Must be prescribed IMLYGIC®.
- Must have private commercial health insurance that covers medication costs for IMLYGIC®.
- Must not be a participant in any federal-, state-, or government-funded healthcare program such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD), or TRICARE.
May not seek reimbursement for value received from the Amgen FIRST STEP™ Program from any third-party payers, including flexible spending accounts or healthcare savings accounts. If at any time patients begin receiving coverage under any federal-, state-,
or government-funded healthcare program, patients will no longer be eligible to participate in the Amgen FIRST STEP™ Program and must call 1-888-65-STEP1 (1-888-657-8371) Monday through Friday, 9:00 AM–8:00 PM ET, to stop participation. Restrictions may apply.
This is not health insurance. Program invalid where otherwise prohibited by law.
§Other restrictions apply. Not valid where prohibited by law. Amgen reserves the right to revise or terminate this program, in whole or in part, without notice at any time.
- Program covers out-of-pocket medication costs for IMLYGIC® only. Program does not cover any other costs related to office visit or administration of IMLYGIC®.
- No out-of-pocket cost for first dose or cycle; $25 out-of-pocket cost for subsequent dose or cycle; maximum benefit of $10,000 per patient per calendar year. Patient is responsible for costs above these amounts.
- Ongoing activation of the Amgen FIRST STEP™ card is contingent on the submission of the required Explanation of Benefits (EOB) form by the healthcare provider’s office within 45 days of use of the Amgen FIRST STEP™ card. Patients will be responsible for reimbursing the program for all amounts paid out if the EOB for the date of service is not received within 45 days.
For eligible uninsured patients
The Safety Net Foundation
The Amgen Safety Net Foundation is a nonprofit patient assistance program that helps qualifying uninsured patients access Amgen medicines, including IMLYGIC®, at no cost. For more information, visit www.amgensafetynetfoundation.com, or call 1-888-SN-AMGEN (1-888-762-6436).
Other co-pay resources
Independent Co-pay Foundations**
Patients who need assistance with out-of-pocket costs for melanoma medication may be eligible for assistance from an Independent Nonprofit Co-pay Foundation. For contact information or to be referred to an independent co-pay foundation, visit amgenassist360.com, or call 1-888-4ASSIST (1-888-427-7478).
**Provided through independent charitable patient assistance programs that set their own eligibility criteria. Amgen has no control over third party programs and provides referrals as a courtesy only.