Reinforce your decision to prescribe ABSORICA by writing DAW-1 every time
TOOLS & RESOURCES
CoverMyMeds® helps physicians and pharmacists complete Prior Authorization and other insurance coverage determination forms for any drug and almost all drug plans.
iPLEDGE® Program Website
Visit www.ipledgeprogram.com for complete iPLEDGE® program information.
ABSORICA Copay Card Program
The ABSORICA Copay Card Program offers ABSORICA patients a discount coupon card to help cover the cost of their treatment. Certain eligibility requirements and restrictions apply. Visit absorica.com/savingsSummary of Program:
- For commercially-insured patients only*
- Present discount coupon card to pharmacy
- Call our Help Desk at 1-855-820-9189 for more processing information
- Valid for 5 refills and subject to applicable program maximum restrictions
Patients are not eligible if prescriptions are paid in part or full by any state- or federally-funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DoD, or TriCare and where prohibited by law.
ABSORICA Patient Assistance Program (PAP)
Available for uninsured and underinsured patients who need assistance paying for their medication.
To be eligible for the PAP, a patient must be a US resident (including Puerto Rico) and must not have existing drug coverage for ABSORICA under any prescription drug benefit, including private insurance, Medicare, Medicaid, or other government insurance programs or be in the 90-Day Waiting Period for Medicare coverage. Your patient's income must also be at or below 400% of the Federal Poverty Level (FPL) and they must be registered with the iPLEDGE® Program.
Medical Necessity Letter
With this form, you can attest that your patient agrees to complete the iPLEDGE® program requirements, so they can begin treatment on ABSORICA.
Denial of Coverage Form
If your patient’s prior authorization for ABSORICA is denied, you can appeal on their behalf with this form.
Please see the ABSORICA Medication Guide or call 1‑888‑726‑2299 for more product information.
You are encouraged to report all side effects or Adverse Drug Events (ADEs) of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. You are also encouraged to report side effects or ADEs to our Drug Safety Department at 1‑800‑406‑7984 or drug.safetyUSA@sunpharma.com (preferred) with as much information as available.