How to Fill Out and Submit Your DUPIXENT MyWay Reimbursement Form

The DUPIXENT MyWay reimbursement form is how you get money back from the manufacturer after paying out of pocket for a DUPIXENT (dupilumab) prescription that your copay card should have covered. Sanofi and Regeneron run the program alongside the DUPIXENT MyWay Copay Card, and it’s open only to patients with commercial health insurance. Fill out the form, attach proof of what you paid, submit it through the portal or by fax within 90 days, and the program will issue reimbursement up to the annual benefit cap of $13,000.1DUPIXENT. Frequently Asked Questions

Who Can Use the Form

The copay program is limited to patients with commercial coverage: employer plans, exchange plans, and federal or state employee plans all qualify. You also need to live in the 50 states, Washington D.C., Puerto Rico, Guam, or the U.S. Virgin Islands, and your prescription has to be for an FDA-approved indication.2DUPIXENT. DUPIXENT MyWay Copay Card and Insurance

If any part of your DUPIXENT cost is paid by Medicare, Medicaid, VA, Department of Defense, TRICARE, or any other federal or state program (including state pharmaceutical assistance programs), you are not eligible, and a reimbursement request will be denied.2DUPIXENT. DUPIXENT MyWay Copay Card and Insurance This is a federal rule tied to anti-kickback law, not a program choice the manufacturer can waive.3Office of the Law Revision Counsel. 42 USC 1320a-7b – Criminal Penalties for Acts Involving Federal Health Care Programs

What to Gather Before You Fill It Out

The form asks for three categories of information. Having everything together before you start saves a round of follow-up.

Your Personal and Insurance Details

You need your full legal name, date of birth, mailing address (not a P.O. box for your home address), phone number, and email. If you already have a DUPIXENT MyWay member number, add it so the program can match the request to your file.

For insurance, pull your prescription card and copy down the insurer’s name and phone number, your policy ID, group number, Rx BIN, and Rx PCN. If you also carry separate medical insurance, the form asks for that policy and the policyholder’s name and relationship to you.4Sanofi and Regeneron Pharmaceuticals, Inc. DUPIXENT MyWay Enrollment Form Check every digit against the card. Mismatched insurance numbers are the single most common reason requests stall.

Your Prescription and Prescriber

Note the dosage strength (200 mg/1.14 mL or 300 mg/2 mL) and the date your prescription was written. You’ll also need your prescriber’s full name, office address, NPI number, phone and fax, office contact name, and tax ID.4Sanofi and Regeneron Pharmaceuticals, Inc. DUPIXENT MyWay Enrollment Form Your doctor’s office can supply the NPI and tax ID if you don’t already have them.

Proof of What You Paid

Attach a copy of the pharmacy receipt showing the medication, fill date, and the amount you paid. If your insurance processed the claim, include the Explanation of Benefits (EOB) for that fill, since it shows what the plan paid and what was left for you. Both documents need to be legible and unaltered. Blurry phone photos and cropped receipts are the second big source of delay after insurance errors.

How to Submit It

DUPIXENT MyWay accepts the completed form through three channels. Digital submissions enter the system immediately; faxed paperwork takes a little longer to log.

If you need help filling out the form, call a Case Manager at 1-844-DUPIXENT (1-844-387-4936), Option 1. That line is for questions, not for document submission.8DUPIXENT MyWay. DUPIXENT MyWay Portal – Contact Us

Deadline and Annual Cap

Submit your request within 90 days of paying for the prescription. Waiting longer risks a denial on timing alone, so file as soon as the receipt and EOB are in hand. If you paid for several fills before your copay card was active, submit a separate request for each fill date.

The copay program’s maximum benefit is $13,000 per patient per calendar year. Any reimbursement you receive counts against that cap along with copay reductions already applied at the pharmacy, so the balance available to you depends on what the program has already paid out this year.1DUPIXENT. Frequently Asked Questions

What Happens After You Submit

You’ll get a confirmation by email or in the patient portal, depending on how you set up contact. Processing generally runs several weeks while the program checks your insurance details, confirms eligibility, and matches the payment amount to your pharmacy records.

Approved claims are paid directly to you. If the program needs more information or denies the claim, you’ll get a notice saying why. The usual culprits are mismatched insurance details, missing receipts, and illegible documents, and in each case you only need to send the missing piece rather than start over. To check status on a pending request, log into the portal or call a Case Manager at 1-844-387-4936, Option 1.9DUPIXENT. DUPIXENT MyWay Support for Patients

A Note on Taxes

Money you get back from DUPIXENT MyWay isn’t income; it’s a return of what you spent. But if you itemize medical expenses on your tax return, you can only deduct costs you actually bore, so subtract any reimbursed amounts from your medical total for the year.10Internal Revenue Service. Medical and Dental Expenses Keep a note of which fills were reimbursed so your records match at filing time.