Determine drug coverage for patients prescribed XCOPRI based on the patient’s individual health plan
Determine the information that may be necessary to help obtain a PA decision from a patient’s insurer
SK life science Inc., may provide XCOPRI for free to eligible patients who do not have prescription drug or health insurance coverage and who, without assistance, cannot afford XCOPRI‡
You can sign a Patient Authorization for the SK life science navigator program electronically. Click the link below to get started.
You can fill out and sign the Patient Assistance Program (PAP) Application electronically. Click the link below to get started.
If you are applying for the Patient Assistance Program because you are unable to afford your XCOPRI, you are required to complete a financial hardship letter.
Always talk to a healthcare provider if there are any questions.
‡Patients must meet eligibility criteria for PAP, which includes: 1) US resident, 2) on-label diagnosis, 3) meets financial threshold, 4) patient is uninsured, functionally uninsured, or has a financial hardship.
This is a templated Letter of Medical Necessity for office staff to fill out and provide to insurers.
For patients who have been denied coverage for XCOPRI® (cenobamate tablets) CV, office staff may use this templated Letter of Appeal to advocate for coverage.
For Medicare Part D patients that have a high copay for their XCOPRI® (cenobomate tablets) CV, office staff are able to use this template to write a Medicare Tier Exception Letter which may make their copay more affordable.
This is a one-page document that will provide offices and patients information about Medicare Low Income Subsidy/Extra Help program and how to apply.