Patient Savings Program Help Desk
For inquiries about the Patient Savings Program
Patient Authorization Form (PAF)
Must be signed to utilize Access 360 patient-specific support.
Programs for Patients:
Synagis® (palivizumab) Patient Savings Program
The Synagis Patient Savings Program assists qualified Synagis patients with their out-of-pocket costs for Synagis. Eligible patients may have access to up to $2,000 to assist with Synagis out-of-pocket costs.
Patients are responsible for the first $30 of each Synagis dose. There are no income requirements to participate in the program.
Synagis Patient Savings Program Support Process
Must meet all criteria:
- Be prescribed Synagis for use that is consistent with the product label
- Have a copay/coinsurance greater than $30
- Be commercially insured
- Patients are ineligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to, Medicare Part D, Medicaid, Medigap, VA, DoD, or TRICARE, or where prohibited by law.
Eligibility rules apply. Additional restrictions may apply.
How the Program Works
- You may be contacted by a pharmacy, home care clinic, or prescriber’s office informing you that you have an out-of-pocket cost for your Synagis dose.
- If you are told that your out-of-pocket costs are more than $30, and you meet the other program eligibility requirements, ask to be enrolled in the Synagis Patient Savings Program. Your pharmacy, home care clinic, or prescriber’s office can help you do this online, or you can enroll yourself by calling the Help Desk at 1-844-ASK-A360 (1-844-275-2360).
- If you meet the program’s eligibility criteria, a Synagis Patient Savings Program account will be created for you.
- Pay the first $30 of the Synagis out-of-pocket costs (per dose), and your pharmacy, home care clinic, or prescriber’s office will use the Program to cover the balance, up to $2,000 per season.
Important Safety Information
What is Synagis® (palivizumab)?
Synagis is a prescription medication that is used to help prevent a serious lung disease caused by respiratory syncytial virus (RSV) in children at high risk for severe lung disease from RSV.
Who should not receive Synagis?
Children should not receive Synagis if they have ever had a severe allergic reaction to it. Signs and symptoms of a severe allergic reaction could include itchy rash; swelling of the face; difficulty swallowing; difficulty breathing; bluish color of the skin; muscle weakness or floppiness; a drop in blood pressure; and/or unresponsiveness. If your child has any of these signs or symptoms of a severe allergic reaction after getting Synagis, be sure to tell your child’s healthcare provider or get medical help right away.
How is Synagis given?
Synagis is given as a shot, usually in the thigh muscle, each month during the RSV season. Your child should receive their first Synagis shot before the RSV season starts, to help protect them before RSV becomes active. When RSV is most active, your child will need to receive Synagis shots every 28-30 days to help protect them from severe RSV disease for about a month. Your child should continue to receive monthly shots of Synagis until the end of RSV season. Your child may still get severe RSV disease after receiving Synagis. If your child has an RSV infection, they should continue to get their monthly shots throughout the RSV season to help prevent severe disease from new RSV infections.
The effectiveness of Synagis shots given less than monthly throughout the RSV season has not been established.
What are the side effects of Synagis?
Possible, serious side effects include severe allergic reaction, which may occur after any dose of Synagis. Such reactions may be life-threatening or cause death. Unusual bruising and/or groups of tiny red spots on the skin have also been reported.
Common side effects of Synagis include fever and rash. Other possible side effects include skin reactions around the area where the shot was given (like redness, swelling, warmth, or discomfort).
Please see accompanying full product information, including patient information.
Synagis is a registered trademark of the AstraZeneca group of companies.