Find the enrollment forms you'll need to help patients access ENSPRYNG after it's been prescribed, including for coverage, reimbursement and financial assistance services. There are also tips for composing a letter of medical necessity and appeal letter.
To learn more about the resources available to help your practice, including information on benefits investigations and prior authorizations, go to Helpful Resources for Your Practice.
ENSPRYNG Access Solutions can help your patients better understand their coverage, find financial assistance options, learn how to get ENSPRYNG, understand which specialty pharmacy their health insurance plan requires, reverify coverage if needed and enroll in additional support options in the event of a coverage delay.
To enroll your patient in ENSPRYNG Access Solutions you must complete the prescriber section of the ENSPRYNG Start Form and your patient must provide their written consent.
Your patient's consent authorizes ENSPRYNG Access Solutions to discuss their health information with you and their health insurance provider. Your patient can provide their written permission by completing either the patient consent section of the ENSPRYNG Start Form or the optional Patient Consent Form.
Both the prescriber and patient consent sections are required. We must have both sections completed before we can help you.
The Genentech Patient Foundation provides free ENSPRYNG to people who don’t have insurance coverage or who have financial concerns and meet eligibility criteria.
The following forms are needed for applying for assistance from the Genentech Patient Foundation. Learn more about the Genentech Patient Foundation and other resources programs.
Includes patient, insurance and prescription information. Page two must be completed and submitted by the prescriber.
This form is signed and dated by your patient, giving written permission for ENSPRYNG Access Solutions to discuss their health information with you and the patient's health insurance plan.
This guide provides tips to help you draft a letter of medical necessity. A sample letter is also included for your reference.
This guide provides tips to help you draft an appeal letter. A sample letter is also included for your reference.
Use the links below to find additional information to enclose in your letter of medical necessity or appeal letter:
ENSPRYNG [prescribing information]. South San Francisco, CA: Genentech, Inc. 2022.
ENSPRYNG [prescribing information]. South San Francisco, CA: Genentech, Inc. 2022.
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Jarius S, Wildemann D, Paul F. Neuromyelitis optica: clinical features, immunopathogenesis and treatment. Clinical and Experimental Immunology. 2014;176:149–164. doi:10.1111/cei.12271
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Yamamura T, Kleiter I, Fujihara K, et al. Trial of satralizumab in neuromyelitis optica spectrum disorder. N Engl J Med. 2019;381(22):2114-2124.
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Huda S, Whittam D, Bhojak M, et al. Neuromyelitis optica spectrum disorders. Clinical Medicine. 2019; 19(2):169–176.
Chihara N, Aranami T, Sato W, et al. Interleukin 6 signaling promotes anti-aquaporin 4 autoantibody production from plasmablasts in neuromyelitis optica. Proc Natl Acad Sci USA. 2011;108(9):3701-3706.
Chihara N, Aranami T, Sato W, et al. Interleukin 6 signaling promotes anti-aquaporin 4 autoantibody production from plasmablasts in neuromyelitis optica. Proc Natl Acad Sci USA. 2011;108(9):3701-3706.
Knapp RK, Hardtstock F, Wilke T, et al. Evaluating the economic burden of relapses in neuromyelitis optica spectrum disorder: a real-world analysis using German claims data. Neurol Ther. 2022;11:247-263. https://doi.org/10.1007/s40120-021-00311-x
Knapp RK, Hardtstock F, Wilke T, et al. Evaluating the economic burden of relapses in neuromyelitis optica spectrum disorder: a real-world analysis using German claims data. Neurol Ther. 2022;11:247-263. https://doi.org/10.1007/s40120-021-00311-x
Contentti EC, Rojas JI, Cristiano E, et al. Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice. Mult Scler Relat Disord. 2020;45:102428. doi: 10.1016/j.msard.2020.102428
Contentti EC, Rojas JI, Cristiano E, et al. Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice. Mult Scler Relat Disord. 2020;45:102428. doi: 10.1016/j.msard.2020.102428
Takeshita Y, Obermeier B, Cotleur AC, et al. Effects of neuromyelitis optica-IgG at the blood-brain barrier in vitro. Neurol Neuroimmunol Neuroinflamm. 2016;4(1):e311. doi:10.1212/NXI.0000000000000311
Takeshita Y, Obermeier B, Cotleur AC, et al. Effects of neuromyelitis optica-IgG at the blood-brain barrier in vitro. Neurol Neuroimmunol Neuroinflamm. 2016;4(1):e311. doi:10.1212/NXI.0000000000000311
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Obermeier B, Daneman R, Ransohoff RM. Development, maintenance and disruption of the blood-brain barrier. Nat Med. 2013;19(12):1584-1596. doi:10.1038/nm.3407
Chugai Pharmaceutical Co, LTD. SMART-Ig. Accessed February 17, 2022. https://www.chugai-pharm.co.jp/english/ir/rd/technologies/files/eChugaiProprietaryTechnologies.pdf
Chugai Pharmaceutical Co, LTD. SMART-Ig. Accessed February 17, 2022. https://www.chugai-pharm.co.jp/english/ir/rd/technologies/files/eChugaiProprietaryTechnologies.pdf
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Igawa T, Tsunoda H, Kuramochi T, Sampei Z, Ishii S, Hattori K. Engineering the variable region of therapeutic IgG antibodies. MAbs. 2011;3(3):243-252.
Data on file. Genentech, Inc. South San Francisco, CA.
Data on file. Genentech, Inc. South San Francisco, CA.
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Barros PO, Cassano T, Hygino J, et al. Prediction of disease severity in neuromyelitis optica by the levels of interleukin (IL)-6 produced during remission phase. Clin Exp Immunol. 2016;183:480-489.
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