The Arikayce inLighten enrollment form is a combined prescription and patient-support application your prescriber submits to start you on Arikayce (amikacin liposome inhalation suspension) for refractory MAC lung disease. Download it at arikayce.com, complete the prescriber and patient sections, and send it in by fax to (800) 604-6027 or by email to enrollment@inlightensupport.com.1Insmed. Arikayce inLighten Enrollment Form Once it lands, an inLighten Coordinator takes over the insurance verification, prior authorization follow-up, and specialty pharmacy routing.
Before You Start Filling It Out
Required fields on the form are marked with asterisks, and incomplete fields slow processing.1Insmed. Arikayce inLighten Enrollment Form Gathering everything in one place first is the single best thing you can do to keep the submission moving.
What You Need From the Patient Side
- Scanned copies of both sides of your pharmacy insurance card. The form asks for plan name, primary insurance ID number, group number, BIN, PCN, and the plan’s phone number.
- Your plan type: private or commercial, Medicare Advantage, Medicare Part D, Medicaid, TRICARE, or another category. You check a box.
- Full legal name, date of birth, gender, physical address (no P.O. boxes), a separate mailing address if yours differs, and a mobile phone number.
What the Prescriber Needs to Have Ready
- The prescriber’s National Provider Identifier (NPI). This is a required field.
- A list of your current medications and any known drug allergies. A full treatment history is not asked for on the form itself, though the prescriber will need that documentation separately for prior authorization.
- The ICD-10-CM diagnosis code for pulmonary mycobacterial infection, A31.0.2Centers for Medicare & Medicaid Services. ICD-10-CM/PCS MS-DRG v37.0 Definitions Manual
Filling Out the Prescriber Section
The form runs about four pages and splits cleanly in two. Your doctor or infectious-disease specialist completes page 1. This page captures the prescription itself: product name (Arikayce 590 mg/8.4 mL), once-daily dosing, the prescriber’s NPI, and office contact information.3Insmed. Arikayce inLighten Enrollment Form Guide The prescriber certifies that therapy is medically necessary and that the information is accurate, and confirms that you authorized disclosure of personal health information to Insmed and agreed to be contacted about inLighten.1Insmed. Arikayce inLighten Enrollment Form
Choosing a Specialty Pharmacy
Arikayce is distributed exclusively through a limited network, so the form includes a checkbox for your preferred pharmacy:1Insmed. Arikayce inLighten Enrollment Form
- Amber Specialty Pharmacy
- PANTHERx RARE Pharmacy
- VytlOne Specialty Pharmacy
If you don’t check a preference, inLighten assigns one. All three are experienced with respiratory and rare-disease medications.
Filling Out the Patient Section
Page 3 is yours. Fill in your personal information and insurance details, then look carefully at the signature area, because this is where people stumble. There are two separate signature blocks, and both need your signature and the date.1Insmed. Arikayce inLighten Enrollment Form
The first signature authorizes the use and disclosure of your protected health information to the inLighten program, consistent with the HIPAA authorization on page 4. The second signature enrolls you in the patient support program and consents to processing of your health information as described on that same page. A missing date on either one is one of the fastest ways to get the form sent back.
How to Submit the Completed Form
Once both sections are complete and signed, send the form by one of two methods:3Insmed. Arikayce inLighten Enrollment Form Guide
- Fax: (800) 604-6027
- Email: enrollment@inlightensupport.com
There is no mailing address. Attach scanned copies of both sides of your pharmacy insurance card along with the form. If you fax, confirm the transmission went through. A failed fax leaves no trace on the receiving end, and you’ll simply never hear anything back.
What Happens After You Submit
When the inLighten hub receives your completed form, you’re assigned an inLighten Coordinator who becomes your single point of contact for several things at once:3Insmed. Arikayce inLighten Enrollment Form Guide
- Insurance verification. The coordinator contacts your insurer to confirm coverage and identify what you’ll owe.
- Prior authorization support. Arikayce is a high-cost specialty drug, and virtually every insurer requires prior authorization. Your coordinator keeps you updated through the payer approval process.
- Pharmacy routing. Once insurance approves, the coordinator sends your prescription to your chosen specialty pharmacy, or to one assigned to you.
You can reach the inLighten support line at 833-LIGHT-00 (833-544-4800), Monday through Friday, 8 AM to 8 PM Eastern, to check status or ask questions while you wait.4Insmed. ARIKAYCE Patient Support
Who the Form Is Actually For
Arikayce was approved under the FDA’s Limited Population Pathway and is reserved for adults with limited or no alternative treatment options. It treats MAC lung disease in patients who did not achieve negative sputum cultures after at least six consecutive months on a multidrug background regimen.5U.S. Food and Drug Administration. ARIKAYCE Approval Package That regimen must include at least two agents from the standard MAC classes: a macrolide such as azithromycin or clarithromycin, ethambutol, or a rifamycin like rifampin or rifabutin. Arikayce is not recommended for non-refractory MAC lung disease, so if standard therapy is still working or has not been tried for long enough, the enrollment form does not apply yet.
The Copay Savings Program
The inLighten program offers a Copay Savings Program for eligible patients with commercial or private insurance, and participants may pay as little as $0 per month in copays. You must be at least 18, reside in the 50 U.S. states, the District of Columbia, or Puerto Rico, and have commercial or private insurance that covers Arikayce.4Insmed. ARIKAYCE Patient Support The program has limits on the total benefit, and you’re responsible for copay amounts above those limits. Insmed does not publicly disclose the annual cap.
The copay program is not available to patients with Medicare, Medicaid, TRICARE, VA coverage, or similar government insurance, or to cash-paying patients.4Insmed. ARIKAYCE Patient Support Patients on government insurance who need help with out-of-pocket costs may be eligible for assistance through independent copay charity foundations, which operate separately from Insmed. Your inLighten Coordinator can point you to those resources. No Insmed-sponsored assistance program for uninsured patients is publicly listed; calling 833-544-4800 is the best way to ask what options exist in your situation.
If your insurance later changes or your copay assistance needs adjustment, contact your coordinator instead of starting a new enrollment form.