Patients who are enrolled in any federal or state healthcare program,
including, without limitation, Medicaid, Managed Medicaid, Medicare, Medicare Advantage,
Medigap, CHAMPVA, TriCare, Veterans Affairs (VA), or Department of Defense (DoD), or any
state or patient assistance program are not eligible for Kyowa Kirin Cares Co-Pay Assistance
Program. The Kyowa Kirin Cares Co-Pay Assistance Program for CRYSVITA helps commercially
insured individuals who are residents of the United States (including the United States
territories) and who are prescribed CRYSVITA for a use approved by the Food and Drug
Administration (FDA) pay for their eligible out-of-pocket costs and cost-sharing for
CRYSVITA and the associated cost-sharing for drug administration, up to a specified maximum
benefit per calendar year. To learn the maximum benefit of financial assistance available to
you under the Kyowa Kirin Cares Co-Pay Assistance Program, call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737). Either the
patient, or the patient’s legal guardian or representative, must personally enroll in the
Kyowa Kirin Cares Co-Pay Assistance Program. Health insurance plans, pharmacy benefit
managers, employers, payors, or any of their representatives or agents are prohibited from
enrolling patients or assisting patients with enrolling in the Kyowa Kirin Cares Co-Pay
Assistance Program.
Note that individuals residing in Massachusetts or Rhode Island (or elsewhere as
prohibited by law) may not be eligible for financial assistance related to the
administration/injection of CRYSVITA. In order to be eligible for the Program, individuals
must provide a signed authorization compliant with the Health Insurance Portability and
Accountability Act of 1996 and the regulations thereunder (collectively “HIPAA”). The
Program does not cover the costs of physician office visits or evaluations, blood work or
other testing, or transportation or other related services. Individuals may not seek
reimbursement from any health savings, flexible savings, or other healthcare reimbursement
account for any amounts received from the Co-Pay Assistance Program. Claims accrued 90 days
prior to enrollment in Kyowa Kirin Cares will not be eligible for Co-Pay Assistance. The Program is NOT insurance. Void if copied, transferred,
purchased, altered, or traded, and where prohibited and restricted by law. For additional
terms and conditions, call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737).
The above set of Terms and Conditions are subject to change at any time without
prior notification. Kyowa Kirin reserves the right to make eligibility determinations, to
set parameters for its Programs, to monitor participation, and to change, modify, or
discontinue its Programs at any time without notice.
