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Resources for you and your patients

Simple steps from prescription to delivery

Once you decide to prescribe POMBILITI + OPFOLDA, here’s what happens next:

1

Once you complete the Patient Referral Form (PRF), send it to AMICUS ASSIST®

  • Fax number: 1-833-264-2873
2

A Case Manager will reach out to you after you prescribe POMBILITI + OPFOLDA and will also contact your patient

AMICUS ASSIST will:

  • Confirm if a Prior Authorization is required
  • Provide an explanation of the patient’s eligibility and potential financial assistance options
  • Provide additional reimbursement support
3

Depending on the treatment setting, AMICUS ASSIST will do one of the following:

  • Triage the Patient Referral Form to the Specialty Pharmacy (SP). The SP will work directly with the prescriber's office to confirm the prescription and fill requests for ancillary supplies
  • Contact the prescriber to review the ordering process for Direct Purchase orders
4

AMICUS ASSIST will help manage the POMBILITI + OPFOLDA delivery based on site of care

Patient referral form-thumbnail

Patient referral form

A form requiring patient and prescriber information to get patients started on POMBILITI + OPFOLDA

Download form

Patient referral form

Patient referral form-thumbnail

A form requiring patient and prescriber information to get patients started on POMBILITI + OPFOLDA

Download form

Additional resources

Product ordering information-thumbnail

POMBILITI + OPFOLDA Product Ordering Information

Provides NDC codes and information on pharmacy and distributor networks

Download
Billing and coding reference-thumbnail

POMBILITI + OPFOLDA Billing & Coding Guide

A sample billing and coding guide with sample CMS‑1450 and CMS‑1500 claim forms

Download

Videos

Mechanism of Action

Dosing and Administration

Have your patients reach out to AMICUS ASSIST

AMICUS ASSIST is a program that provides dedicated support to individuals who have been prescribed an Amicus medication for an approved use. We strive to help patients navigate the financial and insurance-related aspects of their treatment while providing personalized assistance every step of the way.

Financial support

We are committed to helping your patients get access to treatment.

AMICUS ASSIST is proud to help identify possible sources of financial assistance including:

Co-Pay Assistance*

Eligible commercially or privately insured patients may pay as little as $0 per month for treatment

Amicus Patient Assistance Program

For eligible uninsured or underinsured patients†

Support from independent charitable foundations

AMICUS ASSIST can help identify independent charitable foundations that may be able to provide support. These foundations exist independently of Amicus and have their own eligibility criteria and application processes. Availability of support from the foundations is determined solely by the foundations

*Co-pay assistance is only valid for patients using commercial or private insurance for their Amicus medication. It is not valid for prescriptions reimbursed in whole or in part by Medicare, Medicaid, Veterans Administration, TRICARE, Department of Defense, similar federal or state programs, or where prohibited by law. Offer is only available for US residents who have a valid prescription for an Amicus product. In accordance with state law, infusion-related costs are not covered for individuals residing in RI. Patients must be prescribed the medication for an approved use. Co-pay assistance is subject to annual maximum limits. Additionally, patients cannot seek reimbursement from their health insurance or other patient assistance programs for their co-pay. Amicus reserves the right to rescind, revoke, or amend this offer without notice.

†The Amicus Patient Assistance Program provides free product to those who qualify. Contact AMICUS ASSIST for details.

Amicus makes no representation or guarantee concerning reimbursement or coverage for any service or item. Information provided through the AMICUS ASSIST program does not constitute medical advice and is not intended to be a substitute for a consultation with a licensed healthcare provider or applicable third-party payer(s). Amicus reserves the right to modify the program at any time without notice.

AMICUS ASSIST is a program that provides dedicated support to individuals who have been prescribed an Amicus medication. We strive to help patients navigate the financial and insurance-related aspects of their treatment while providing personalized assistance every step of the way. Call us toll-free at:

1-833-AMICUS-A (1-833-264-2872), Monday to Friday, 8AM – 8PM ET

Visit AmicusAssistHCP.com for additional resources

References:

  1.  Johnson FK, Kang J, Mondick J, et al. Mechanism of action, plasma total GAA protein PK profiles and PK/PD relationships differ between cipaglucosidase alfa/miglustat and alglucosidase alfa in patients with late-onset Pompe disease. Poster presented at: The 18th Annual WORLDSymposium™; February 7-11, 2022; San Diego, CA, and virtually.
  2.  POMBILITI. Prescribing information. Amicus Therapeutics US, LLC; 2024.
  3.  Schoser B, Roberts M, Byrne BJ, et al. Safety and efficacy of cipaglucosidase alfa plus miglustat versus alglucosidase alfa plus placebo in late-onset Pompe disease (PROPEL): an international, randomised, double-blind, parallel-group, phase 3 trial. Lancet Neurol. 2021;20(12):1027-1037.
  4.  OPFOLDA. Prescribing information. Amicus Therapeutics US, LLC; 2024.
  5.  Data on file, Amicus Therapeutics, Inc.
  6.  ZAVESCA®(miglustat). Prescribing information. Actelion Pharmaceuticals US, Inc.