Support to help you get started
VelsipityForMe can assist with understanding your insurance coverage for your prescribed VELSIPITY, connecting you with potential financial support, and helping you get your prescription. Learn more about how VelsipityForMe may be able to help you get started on VELSIPITY.
Meet your Dedicated Care Coordinator
Once enrolled in VelsipityForMe*, your Dedicated Care Coordinator will be your main point of contact and will help guide you through getting started on VELSIPITY. Your Dedicated Care Coordinator can:
*Your physician will get you started with enrolling in VelsipityForMe by completing the enrollment form.
†Eligibility required. Commercially insured patients only. Baseline assessment coordination services are not available for patients enrolled in a state or federally funded health insurance program, or for patients who reside in MI, MN, or RI.
Not enrolled in VelsipityForMe?
Request support from a Dedicated Care Coordinator to help assess your eligibility and get you started.
Various screening support options for eligible, commercially insured patients
Before you start treatment with VELSIPITY, you will need to complete a few screening tests. You and your doctor will decide if these tests will happen in the doctor’s office or at your home. Your Dedicated Care Coordinator may be able to help schedule tests as needed.
Click here and take a closer look at getting started with a video featuring a real gastroenterologist.
At-Home Screening‡
VelsipityForMe can either arrange for a licensed clinician to visit your home or we can send a self-administered device to you with step-by-step instructions, based on screening needs.
Tests will be interpreted by a specialist and shared back with your doctor.
In-Office Screening‡
Your Dedicated Care Coordinator may be able to schedule near-term appointments for certain screening tests to be completed by a provider in an office setting.
†Eligibility required. Baseline assessment coordination services are not available for patients enrolled in a state or federally funded prescription health insurance program, or patients who reside in MI, MN, or RI.
Reimbursement for In-Office Screening§
If you and your doctor decide that all or some of the screenings will be completed in the office, there may be associated out-of-pocket costs.
Eligible patients may be reimbursed up to $2,500 for qualified out-of-pocket expenses. Terms and Conditions apply.
§Eligible patients may be reimbursed up to $2,500 for qualified out-of-pocket expenses related to baseline assessments. Support may be available for patients after assessments have been completed at a provider’s office. Eligibility required. Commercially insured patients only. The baseline assessments medical benefit offer is subject to a maximum one-time benefit of $2,500 for qualified out-of-pocket expenses and includes initial blood tests, ECG screening, eye exam, and baseline skin examination where the full cost is not covered by patient’s insurance. Patients enrolled in a state or federally funded prescription health insurance program or who are residents of MN or RI are not eligible for the medical benefit. Available only to patients who have been diagnosed with an FDA-approved indication for VELSIPITY. No membership fees. This is not health insurance. Terms and Conditions apply.
Pay as little as $0 per month for your VELSIPITY prescription‖
Receive up to 2 years of medication at no
cost, shipped through Interim Care Rx
If a delay or coverage denial occurs during the prior authorization or appeals process, eligible commercially insured patients enrolled in VelsipityForMe may receive free VELSIPITY for up to 2 years, shipped to you through Interim Care Rx. See Terms and Conditions.
Eligibility required. For MN and RI, available up to 6 months. See Terms and Conditions.
No Insurance or Underinsured?
If you have no insurance and need financial assistance, we will refer you to Medicaid if you appear to be eligible. If turned down, we will evaluate you for the Pfizer Patient Assistance Program. If you are eligible, we will provide you VELSIPITY at no cost to you.
Do you have questions about your insurance or cost for your prescribed medication? VelsipityForMe is here to help
Please see the answers to frequently asked questions.
For case-specific questions regarding accessing your prescribed medication, please contact your Dedicated Care Coordinator (DCC) at the phone number provided during your welcome call. If you
do not know your DCC's number, you can contact VelsipityForMe at 1-800-350-3080 and select Option 1 to be connected with a DCC. You can also request to be contacted by a DCC here.
How much should I expect to pay for my VELSIPITY prescription?
What you pay for VELSIPITY may vary based on your specific insurance coverage.
Your DCC can help explain your out-of-pocket costs for VELSIPITY and your eligibility for financial support. If your provider has not yet enrolled you in VelsipityForMe, you can request a DCC here.
For more information on commercial vs government insurance plans, click here.
Are there costs associated with completing the screening tests?
Before you start treatment with VELSIPITY, you will need to complete a few screening tests. You and your doctor will decide if these tests will happen in the doctor’s office or at your home. Your DCC may be able to help schedule tests and provide cost information as needed.
- Tests Done at Home*: VelsipityForMe can either arrange for a licensed clinician to visit your home, or we can send a self-administered device to you with step-by-step instructions, based on screening needs. These tests are at no cost to you.
- Tests Done in Doctor’s Office: There may be associated out-of-pocket costs. Commercially insured patients who meet additional eligibility requirements may be reimbursed up to $2,500 for qualified out-of-pocket expenses.† See Terms and Conditions.
*Eligibility required. Baseline assessment coordination services are not available for patients enrolled in a state or federally funded prescription health insurance program, or patients who reside in MI, MN, or RI.
†Eligible patients may be reimbursed up to $2,500 for qualified out-of-pocket expenses related to baseline assessments. Support may be available for patients after assessments have been completed at a provider’s office. Eligibility required. Commercially insured patients only. The baseline assessments medical benefit offer is subject to a maximum one-time benefit of $2,500 for qualified out-of-pocket expenses and includes initial blood tests, ECG screening, eye exam, and baseline skin examination where the full cost is not covered by patient’s insurance. Patients enrolled in a state or federally funded prescription health insurance program or who are residents of MN or RI are not eligible for the medical benefit. Available only to patients who have been diagnosed with an FDA-approved indication for VELSIPITY. No membership fees. This is not health insurance. Terms and Conditions apply.
How do I know if I am eligible to pay as little as $0 for VELSIPITY through the Copay Savings Program?
If you’re a commercially insured patient* prescribed VELSIPITY, click here to check your eligibility for the VELSIPITY $0 Copay Savings Program. If you are unable to confirm your eligibility or have additional questions, call 1-800-350-3080 to speak to a DCC. Terms and conditions apply.
*Eligibility required. Commercially insured patients only. The maximum prescription benefit offer per patient is $4,000 to $16,000 per calendar year. Patients enrolled in a state or federally funded prescription health insurance program are not eligible. No membership fees. This is not health insurance. Available only to patients who have been diagnosed with an FDA-approved indication for VELSIPITY. Terms and Conditions apply.
What if my insurance provider denies coverage of VELSIPITY?
If your medication has been delayed or denied, eligible patients enrolled in VelsipityForMe may have the following options available:
- For eligible, commercially insured patients during the appeal process, VELSIPITY may be available at no cost for up to 2 years through VelsipityForMe Interim Care Rx.* Terms and Conditions apply.
- For more information about Interim Care Rx, reach out to your DCC.
- For government-insured patients, if the appeal request is denied more than once, patients may be eligible for patient assistance that is determined by financial need.
To qualify for financial assistance, additional documentation may need to be submitted.
*Eligibility required. Not available for residents of MA or MI. For MN or RI, up to 6 months.
Once my insurance approves the medication, how do I access my VELSIPITY prescription?
If you’re enrolled in VelsipityForMe, a DCC will arrange for the pharmacy to contact you to schedule the shipment of VELSIPITY.
- If you’re not enrolled in VelsipityForMe, your doctor will send the prescription directly to your Specialty Pharmacy. The Specialty Pharmacy will call you to arrange shipment of VELSIPITY.
- Regardless of whether you are enrolled in VelsipityForMe, please make sure to answer the phone when it rings, so that the pharmacy can reach you to send you your medication.
For more information on retail vs Specialty Pharmacy, click here.
What do I do if my insurance changes?
Your health plan may change from time to time—for example, if you have commercial insurance and switch employers, or if you’re on Medicare and change your plan during the open enrollment period. As soon as your insurance information changes, contact your DCC to update your information on file.
If you are seeking financial assistance or your financial situation has changed, you should also contact your DCC to help identify resources you may be eligible for.
For case-specific questions regarding accessing your prescribed medication, please contact your DCC at the phone number provided during your welcome call. If you do not know your DCC's number, you can contact VelsipityForMe at 1-800-350-3080 and select Option 1 to be connected with a DCC. You can also request to be contacted by a DCC here.
What should I consider when reviewing health plan coverage options for next year during my health plan and/or employer’s annual open enrollment period?
If your health insurance or prescription benefits change, your DCC can help you understand your new coverage and work with your provider to seek insurance approval if needed.
For case-specific questions regarding accessing your prescribed medication, please contact your DCC at the phone number provided during your welcome call. If you do not know your DCC's number, you can contact VelsipityForMe at 1-800-350-3080 and select Option 1 to be connected with a DCC. You can also request to be contacted by a DCC here.
To learn when open enrollment is, speak to your health insurance provider or your employer (if you have insurance through them).
For patients enrolled in a Medicare or Medicare Advantage plan, changes for the next year can be made between October 15th and December 7th.
Glossary
Appeal: If your health insurance denies prior authorization for a service or medication, you have the right to appeal the decision. This means you or your healthcare provider can ask the insurance company to review and reconsider the denial. You may need to provide additional information to show why the service or medication is medically necessary.
Coinsurance: The percentage of the cost you pay for a medication or service after you meet your deductible. For example, if your health insurance plan has 20% coinsurance and your medication costs $100, you will pay $20, and your insurance will pay $80.
Commercial Health Insurance: Also known as private insurance, this is non-government insurance that covers all or part of your medical costs. It may be purchased by individuals or provided through an employer, most commonly as part of a benefits package.
Copay: A copay (or copayment) is a fixed amount you pay for a covered healthcare service after you have met your deductible. For example, you might pay $20 for a doctor’s visit, and your health insurance covers the rest of the cost.
Deductible: The amount a patient must pay for covered healthcare expenses before their insurance plan begins to pay for covered expenses.
Denial or Denied: This means your health plan doesn't cover the service or medication because it's not included in your benefits, or there are certain limitations as to when the benefits are available. If your insurance denies benefits for a service or medication, you are liable for the entire amount.
Maximum Out-of-Pocket Cost: A limit on how much money you will have to pay for your covered healthcare services within the plan year. Typically, when the maximum out-of-pocket cost is met, your health insurance plan will pay 100% of healthcare costs for the rest of the year.
Medicaid: A state-government–funded healthcare program that helps provide healthcare coverage and drug benefits for low-income individuals.
Medicare: A federal-government–funded healthcare program that provides healthcare coverage options and drug benefits for people who are aged 65 years or older, or those under the age of 65 who qualify based on their disabilities.
Medicare Advantage Plan (Medicare Part C): A Medicare plan that covers services under both Medicare Part A and B. This plan may also offer prescription drug coverage. This type of plan is sold through commercial health insurance (private insurance) companies that must be approved by Medicare.
Prior Authorization: A process used by some health insurance companies to determine if they would cover a prescribed medication.
TRICARE: A military healthcare program for both active-duty and retired members of the military.