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Patient support tailored to your patients

BECAUSE AATD LOOKS DIFFERENT FOR EVERYONE

When you prescribe GLASSIA [Alpha1-Proteinase Inhibitor (Human)] for your patient, Takeda Patient Support is here for them. Our support specialists can address your patient’s questions and concerns and help get them the information they need.

Need to enroll your patient? Download and fax a printed start form to
1-866-861-1752. To learn more about Takeda Patient Support, visit www.takedapatientsupport.com/
hcp/glassia.

For onboarding, access, and reimbursement assistance, our services include:

  • Benefits investigation to help determine your patient’s insurance benefits and eligibility for certain services
  • Prior authorization (PA), reauthorization, and appeals information
  • Enrollment into the Takeda Patient Support Co-Pay Assistance Program if they qualify*
  • Information about financial assistance options if they’re eligible

Our additional services include:

  • Specialty pharmacy (or site of care) triage and coordination
  • Takeda product infusion training for healthcare providers, as well as home treatment support and education for your patient
  • Arranging for a trained nursing professional to teach your patient or their caregiver how to infuse treatment at home, if requested by your office
  • Directing your patient to community support resources

*To be eligible, you must be enrolled in Takeda Patient Support and have commercial insurance. Other terms and conditions apply. Call us for more details.

How to get your patients
started on GLASSIA

  1. Complete and sign the Start Form
  2. Have your patients sign the Patient Authorization section
  3. Takeda Patient Support will review the Start Form and confirm patient eligibility
  4. Your patients will then receive a welcome call from their dedicated support specialist
  5. The support specialist will get them started on Takeda Patient Support
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Explore patient assistance programs.

Financial assistance options

At Takeda Patient Support, our support specialists will review your patient’s coverage and help them understand what financial options may be available.

For commercially insured patients

The Takeda Patient Support Co-Pay Assistance Program helps eligible, commercially insured patients pay as little as $0 per prescription.*

See below for terms and conditions.

Need assistance?

Our support specialists are never more than a tap or a call away—1-866-888-0660, Monday through Friday, 8:30 am to 8 pm ET.

If English is not your patient’s preferred language, Takeda Patient Support can communicate with them over the phone using a translation service.

*To be eligible, patients must be enrolled in Takeda Patient Support and have commercial insurance. Other terms and conditions apply. Call Takeda Patient Support for more details.

IMPORTANT NOTICE: Takeda’s Co‐pay Assistance Program (“the Program”) provides financial support for commercially insured patients who qualify for the Program. Participation in the Program and provision of financial support is subject to all Program terms and conditions, including but not limited to eligibility requirements, the Program maximum benefit per claim and the annual calendar year Program maximum (“Annual Program Maximum”). The Annual Program Maximum for your prescribed Takeda product can be found by visiting: https://www.takedapatientsupport.com/hcp/glassia.

By enrolling in the Program, you agree that the Program is intended solely for the benefit of you—not health plans and/or their partners. Further, you agree to comply with all applicable requirements of your health plan. The Program cannot be used if the patient is a beneficiary of, or any part of the prescription is covered by: 1) any federal, state, or government‐funded healthcare program (Medicare, Medicare Advantage, Medicaid, TRICARE, etc.), including a state pharmaceutical assistance program (the Federal Employees Health Benefit (FEHB) Program is not a government‐funded healthcare program for the purpose of this offer), 2) the Medicare Prescription Drug Program (Part D), or if the patient is currently in the coverage gap, or 3) insurance that is paying the entire cost of the prescription. No claim for reimbursement of the out‐of‐pocket expense amount covered by the Program shall be submitted to any third‐party payer, whether public or private.

Some health plans have established programs referred to as ‘co‐pay maximizer’ programs. A co-pay maximizer program is one in which the amount of a patient’s out‐of‐pocket costs is adjusted to reflect the availability of support offered by a manufacturer’s co‐pay assistance program. If you are enrolled in a co‐pay maximizer program, your Annual Program Maximum may vary over time to ensure the program funds are used for your benefit (for the benefit of the patient). Takeda also reserves the right to reduce or eliminate the co‐pay assistance available to patients enrolled in an insurance plan that utilizes a co‐pay maximizer program.

If you learn your health plan has implemented a co‐pay maximizer program, you agree to notify the Program immediately by calling 1‐866‐888‐0660. It may be possible that you are unaware whether you are subject to a co‐pay maximizer program when you enroll or re‐enroll in the Program. Takeda will monitor program utilization data and reserves the right to discontinue assistance under the Program at any time if Takeda determines that you are subject to a co‐pay maximizer, or similar program.

The Program only applies in the United States, including Puerto Rico and other U.S. territories, and does not apply where prohibited by law, taxed, or restricted. This does not constitute health insurance. Void where use is prohibited by your insurance provider. If your insurance situation changes you must notify the Program immediately at 1‐866‐888‐0660. Coverage of certain administration charges will not apply for patients residing in states where it is prohibited by law.

This Program offer is not transferable and is limited to one offer per person and may not be combined with any other coupon, discount, prescription savings card, rebate, free trial, patient assistance, co‐pay maximizer, alternative funding program, co‐pay accumulator, or other offer, including those from third parties and companies that help insurers or health plan manage costs. Not valid if reproduced.

By utilizing the Program, you hereby accept and agree to abide by these terms and conditions. Any individual or entity who enrolls or assists in the enrollment of a patient in the Program represents that the patient meets the eligibility criteria and other requirements described herein. You must meet the Program eligibility requirements every time you use the Program. Takeda reserves the right to rescind, revoke, or amend the Program at any time without notice, and other terms and conditions may apply.

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