Ultomiris Patient assistance program
Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Ultomiris medication with our help.Get Started Now
Secure: Your personal and medical information is safe with us
Convenient: Your medication is delivered straight to your door
Ongoing refills: Your medication is refilled automatically
NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.
An introduction to NiceRx(01:52)
Next steps after qualifying(00:38)
Uploading documents and billing(00:50)
SSN & billing information(00:33)
Medication delivery time(00:41)
How it works
Get started by filling out the online enrollment application to find out if you are eligible.
NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified. The pharmaceutical company provides your medication for free and you only pay our service fee.
You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.
Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.
Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.
Your monthly Ultomiris cost savings if eligible
The Ultomiris patient assistance program can provide your medication for free. We simply charge $49 per month for each medication to cover the cost of our services. With NiceRx, you will only pay $49 to obtain your Ultomiris, regardless of the retail price.
Am I eligible for the Ultomiris patient assistance program?
To find out if you are eligible for Ultomiris assistance you can apply online using our enrollment application. Each pharmaceutical company sets its eligibility criteria, and we will review your application individually to determine if you may be eligible. The three main factors to consider are:
- I am a permanent, legal resident of the United States or Puerto Rico
- I am uninsured or my insurance doesn’t cover my medication
- I meet certain income eligibility requirements
How do I apply for the Ultomiris patient assistance program?
Our application process aims to make it as easy as possible to apply for the Ultomiris patient assistance program. The first step is to complete our online enrollment application. We will ask you for details about your healthcare provider, your insurance plan, and your household income as this information is required by the pharmaceutical companies. We may be able to help you apply for other patient assistance programs too, so be sure to tell us about any medications you are taking as well as Ultomiris.
NiceRx will review your application and determine whether you may be eligible for Ultomiris assistance. If so, we will handle the full enrollment process for you and prepare all required documents for your healthcare provider to sign. Once you are successfully enrolled in the Ultomiris patient assistance program, we will help you manage your prescription refills by requesting refills on your behalf throughout your enrollment period. At the end of your enrollment period, we will contact you for updated information and seek to re-enroll you so you can continue to access affordable Ultomiris.
Is NiceRx an Ultomiris coupons provider?
NiceRx is a service provider that helps eligible individuals access the Ultomiris patient assistance program. We do not offer trial offers or free Ultomiris samples. When obtaining your medication through NiceRx, you will only pay $49 a month per medication. This will likely save you more money than if you were to use Ultomiris coupons, discount cards, or Ultomiris copay cards.
Can NiceRx help me get Ultomiris if I have insurance?
NiceRx may be able to help you if your insurance company will not pay for your Ultomiris medication. We may also be able to help if you have a high copay or coinsurance responsibility. Whether you have insurance or not, apply online using our enrollment application to find out more.
How much does Ultomiris cost without insurance?
Ultomiris prices without insurance will vary depending on how much you buy. Prices will also vary by retailer. As a guide, Ultomiris intravenous solution (100 mg/mL) typically costs $6,700 for 3 milliliters.
How much does Ultomiris cost with insurance?
The copay for Ultomiris will vary by the terms of your healthcare plan. To find out what you might need to pay for Ultomiris with insurance, your insurance provider or pharmacist will be able to help you calculate the copay costs with your current insurance.
What is Ultomiris?
Ultomiris is an FDA (Food and Drug Administration) approved medication manufactured by Alexion Pharmaceuticals, Inc. Ultomiris is a complement inhibitor used for:
- The treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH). PNH is a rare genetic disorder in which defective red blood cells break down prematurely and release hemoglobin into your blood. Ultomiris is also the first and only medicine approved in the U.S. to treat children and adolescents with PNH
- Hemolytic Uremic Syndrome
- The treatment of adults and pediatric patients one month and older with the atypical hemolytic uremic syndrome (aHUS) inhibit complement-mediated thrombotic microangiopathy (TMA)
Life-threatening meningococcal infections/sepsis have occurred in patients treated with Ultomiris and may become life-threatening if not treated early.
You should be immunized with a meningococcal vaccine at least 2 weeks before having the first dose of Ultomiris unless the risk of delaying Ultomiris therapy outweighs the risks of developing a meningococcal infection.
Vaccination reduces but does not eliminate, the risk of meningococcal infection. You should be monitored for early signs of meningococcal infections. Ultomiris is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS). Under the Ultomiris REMS, prescribers must enroll in the program.
What doses of Ultomiris are available?
Ultomiris is available in injection form, in the following doses: 300 mg/30 mL (10 mg/mL) in a single-dose vial
Use Ultomiris as prescribed by your doctor. If you’ve been using Soliris, you will need to wait 2 weeks after your last dose of eculizumab before starting treatment with Ultomiris.
Ultomiris will be injected into a vein by a healthcare professional. The initial loading dose is two infusions usually given 2 weeks apart, followed by an infusion once every 4-8 weeks. You will be observed for at least 1 hour after your infusion to make sure you do not have an allergic reaction. The maintenance dose regimen for treatment is based on body weight. The dosing schedule is allowed to occasionally vary within 7 days of the scheduled infusion day.
Ultomiris can have long-lasting effects on your body, even after you have stopped using this medicine. If you have PNH and you stop using Ultomiris, your doctor may need to check your progress for at least 16 weeks after your last dose. If you have aHUS and you stop using Ultomiris, your doctor may need to check you for at least 12 months after your last dose.
Always speak with your healthcare provider about any changes to your dose so they can monitor and evaluate your condition.
Ultomiris active ingredients
Ravulizumab-cwvz is classed as a monoclonal antibody. It is a terminal complement inhibitor that binds to the complement protein C5 with high affinity, stopping it from splitting into C5a and C5b and preventing the production of the terminal complement complex C5b9. Ultomoris prevents terminal complement-mediated intravascular hemolysis in patients with PNH and complement-mediated thrombotic microangiopathy (TMA) in patients with aHUS.
Ultomiris side effects
The most common side effects of Ultomiris in clinical trials include:
- Upper respiratory tract infection
- High blood pressure
- Diarrhea, nausea, vomiting
- Cold symptoms such as stuffy nose, sneezing, sore throat
In rare instances, Ultomiris can cause more serious side effects. These can include:
- Increased risk of infection – Ultomiris affects your immune system, symptoms include muscle pain with flu-like symptoms, fever, rash, headache, nausea or vomiting, confusion
- Gonorrhea – pain or burning when you urinate, pain or swelling of the genital or rectal area, unusual vaginal bleeding, foul discharge from the penis or vagina
- Serious intravascular hemolysis, seen by increased LDH (lactate dehydrogenase) levels with a sudden decrease in PNH clone size or hemoglobin
- If you stop using Ultomiris, tell your doctor if you have any new or worsening symptoms, such as, tiredness, confusion, stomach pain, chest pain, shortness of breath, or swallowing. In men erectile dysfunction, blood in your urine, seizures, or loss of consciousness
Your doctor will assess the benefits of using Ultomiris against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Ultomiris to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Ultomiris drug interactions
Ultomiris can interact with other medications. These include:
- Immune globulin
This list is not exhaustive and other prescription medicines may interact with Ultomiris.
You should not use Ultomiris if you:
- Are allergic to the active ingredient ravulizumab
- Are allergic to any of the other ingredients in Ultomiris
- Are pregnant or are planning to become pregnant – it is not known whether ravulizumab will harm an unborn baby, but having PNH during pregnancy may cause complications in the baby or the mother, such as blood clots, infections, bleeding, miscarriage, premature delivery, or death
- Have unresolved Neisseria Meningitidis infection
- Have a meningococcal infection (such as meningitis or sepsis), or if you are not vaccinated against meningitis
- Are younger than 1 month old
Talk to your doctor before using Ultomiris if you:
- Are taking any of the medications that could interact with Ultomiris
- Are breastfeeding or are planning to breastfeed – do not breastfeed while using Ultomiris, and for at least 8 months after your last dose
Ultomiris is the trademark brand name for ravulizumab manufactured by Alexion Pharmaceuticals, Inc. A generic version of ravulizumab is not available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Ultomiris savings through NiceRx.
*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking the different programs and filling out all the required paperwork for each program. Subject to medication availability.
Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.
**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).
To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.