For people with previously treated locally advanced or metastatic urothelial carcinoma

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Sample Basic Survey

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Personalized dose reminders will be sent to your e-mail. If you would prefer to receive through a text message, please provide your mobile number:

 

I would like to enroll in the FASENRA text message program and I accept the related mobile terms and conditions. Message and data rates apply.

 Yes, I would be willing to be contacted on occasion to participate in market research studies sponsored by AstraZeneca.

By registering today, you will receive information about FASENRA, and may receive information about other respiratory medicines and services related to your condition.

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AstraZeneca respects your personal health information. The information you provide may be used to send health-related materials to you and to develop products, services, and programs. AstraZeneca, or third parties working on our behalf, will not sell or rent personal health information. If in the future you no longer want to receive health-related materials, call 1-800-236-9933. Please visit www.azprivacynotice.com to review our Privacy Notice.

AstraZeneca will not knowingly collect, use, or disclose personally identifiable information from a minor under the age of 18. If you are under the age of 18, please have your parent, guardian, or healthcare professional request the information on your behalf.

FASENRA Savings Program

Eligibility

You may be eligible for this offer if you are insured by commercial insurance.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this program even if you elect to be processed as an uninsured (cash paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico.

Terms of Use

Eligible commercially insured patients with a valid prescription for FASENRA who enroll in this program may pay as little as $0 per administration of FASENRA dependent upon patient’s prescription coverage of FASENRA.

If FASENRA is covered by your health plan:

  • Up to $10,000 per calendar year in assistance for out-of-pocket expenses

If FASENRA is Not covered by your health plan:

  • Prescription fills for 12 months from the date of the initial prescription
  • A prior authorization (PA) Denial and PA Appeal Denial by your health plan are required to be eligible for this program
  • FASENRA must be prescribed for on-label use to be eligible for this program
  • This program is only administered by approved specialty pharmacies

The out-of-pocket costs covered by the program can include the cost of the product itself and the cost of injection administration of the product (program maximum of $100 per injection administration).* Other restrictions may apply. Patient must be enrolled in the program before use. If you have any questions regarding the offer, please call 1-833-360-HELP (1-833-360-4357).

Offer is invalid for claims or transactions more than 180 days from the date of service.

Non-transferable, limited to one person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for FASENRA at the time of purchase.

Patients must have commercial health insurance.

Program covers the cost of the drug and administration, and does not cover the costs for office visits or any other associated costs.

BY USING THIS PROGRAM, YOU AND YOUR PHARMACIST AND/OR PHYSICIAN UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

*Patients are responsible for any cost associated with the administration above the $100 per injection administration assistance provided by the program.

Patients who are residents of Massachusetts, Michigan, Minnesota, or Rhode Island are not eligible for injection administration assistance.

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IMPORTANT SAFETY INFORMATION

Do not receive FASENRA if you are allergic to benralizumab or any of the ingredients in FASENRA.

Do not use to treat sudden breathing problems.

FASENRA may cause serious side effects, including:

  • allergic (hypersensitivity) reactions, including anaphylaxis. Serious allergic reactions can happen after you get your FASENRA injection. Allergic reactions can sometimes happen hours or days after you get your injection. Tell your healthcare provider or get emergency help right away if you have any of the following symptoms of an allergic reaction:
    • swelling of your face, mouth and tongue
    • breathing problems
    • fainting, dizziness, feeling lightheaded (low blood pressure)
    • rash
    • hives

Before receiving FASENRA, tell your healthcare provider about all of your medical conditions, including if you:

  • are taking oral or inhaled corticosteroid medicines. Do not stop taking your corticosteroid medicines unless instructed by your healthcare provider. This may cause other symptoms that were controlled by the corticosteroid medicine to come back
  • have a parasitic (helminth) infection
  • are pregnant or plan to become pregnant. It is not known if FASENRA will harm your unborn baby. Tell your healthcare provider if you become pregnant during your treatment with FASENRA
  • are breastfeeding or plan to breastfeed. It is not known if FASENRA passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you receive FASENRA
  • are taking prescription and over-the-counter medicines, vitamins, or herbal supplements

Do not stop taking your other asthma medicines unless instructed to do so by your healthcare provider.

The most common side effects of FASENRA include: headache and sore throat. These are not all the possible side effects of FASENRA.

Approved Use

FASENRA is a prescription medicine used with other asthma medicines for the maintenance treatment of asthma in people 12 years and older whose asthma is not controlled with their current asthma medicines. FASENRA helps prevent severe asthma attacks (exacerbations) and may improve your breathing. Medicines such as FASENRA reduce blood eosinophils. Eosinophils are a type of white blood cell that may contribute to your asthma.

FASENRA is not used to treat other problems caused by eosinophils and is not used to treat sudden breathing problems. Tell your health care provider if your asthma does not get better or if it gets worse after you start treatment with FASENRA

It is not known if FASENRA is safe and effective in children under 12 years of age.

Please see accompanying full Prescribing Information including Patient Information.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

IMPORTANT SAFETY INFORMATION+

Do not receive FASENRA if you are allergic to benralizumab or any of the ingredients in FASENRA.

Do not use to treat sudden breathing problems.

FASENRA may cause serious side effects, including:

  • allergic (hypersensitivity) reactions, including anaphylaxis. Serious allergic reactions can happen after you get your FASENRA injection. Allergic reactions can sometimes happen hours or days after you get your injection. Tell your healthcare provider or get emergency help right away if you have any of the following symptoms of an allergic reaction:
    • swelling of your face, mouth and tongue
    • breathing problems
    • fainting, dizziness, feeling lightheaded (low blood pressure)
    • rash
    • hives