No matter what type of health insurance you have, and even if you have none at all, there may be some potential options available to help you afford your medicine.
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If you have insurance coverage and need help affording Esbriet, these programs may help:
Esbriet Co-pay Program
With the Esbriet Co-pay Program, eligible patients with commercial insurance could pay as little as $5 per 30-day supply of Esbriet. The rest of your co-pay or co-insurance is covered up to $25,000 in assistance per calendar year.
You may be eligible if you:
- Are taking Esbriet for an FDA-approved use
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Are 18 years of age or older or have
a Legally Authorized Person over the
age of 18 to manage the program
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Have commercial (private or
non-governmental) insurance. This includes plans available
through state and federal health
insurance exchanges
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Live and receive treatment in the
United States or U.S. Territories
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Are not receiving
assistance through the Legacy
Patient Program or any other
charitable organization for the same
expenses covered by the program
- Do not use a state or federal healthcare plan to pay for your medication. This includes, but is not limited to, Medicare, Medicaid and TRICARE
The Co-pay Program (“Program”) is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Legacy Pharma Inc. SEZC medicine. The Program is not available to patients whose prescriptions are reimbursed under any federal, state, or government-funded insurance programs (included but not limited to Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs Programs) or where prohibited by law or by the patient's health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare programs, the patient will no longer be eligible for the Program.
Under the Program, the patient may be required to pay a co-pay. The final amount owed by a patient may be as little as $0 for the Legacy Pharma Inc. SEZC medicine (see Program specific details available at the Program website). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Legacy Pharma Inc. SEZC medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the Legacy Pharma Inc. SEZC medicine.
All participants are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. The Program is only valid in the United States and U.S. Territories, is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. No party may seek reimbursement for all or any part of the benefit received through the Program. The value of the Program is intended exclusively for the benefit of the patient. The funds made available through the Program may only be used to reduce the out-of-pocket costs for the patient enrolled in the Program. The Program is not intended for the benefit of third parties, including without limitation third party payers, pharmacy benefit managers, or their agents. If Legacy Pharma Inc. SEZC determines that a third party has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Program and/or excludes the assistance provided under the Program from counting towards the patient’s deductible or out-of-pocket cost limitations, Legacy Pharma Inc. SEZC may impose a per fill cap on the cost-sharing assistance available under the Program. Submission of true and accurate information is a requirement for eligibility and Legacy Pharma Inc. SEZC reserves the right to disqualify patients who do not comply with Legacy Pharma Inc. SEZC Program Terms and Conditions. Legacy Pharma Inc. SEZC reserves the right to rescind, revoke or amend the Program without notice at any time.
Additional terms and conditions apply. Please visit the Co-pay Program website for the full list of Terms and Conditions.
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Commercial insurance: An insurance plan you get from a private health insurance company. This can be insurance from your job, from a plan you bought yourself or from a Health Insurance Marketplace. Medicare and Medicaid are not considered commercial insurance.
Independent Co-pay Assistance Foundations
An independent co-pay assistance foundation is a charitable organization providing financial assistance to patients with specific disease states, regardless of treatment. Patients who are commercially or publicly insured, including those covered by Medicare and Medicaid, can contact the foundations directly to request assistance. Eligibility requirements, all aspects of the application process, turnaround times and the type or amount of assistance available (if any) can vary by foundation.
These foundations may be able to help. Please check their websites for up-to-date information.
These organizations are independent of Legacy Pharma Inc. SEZC and may require you to provide personal or financial information directly to the organization to enroll in their respective programs. Legacy Pharma Inc. SEZC cannot share any information you have provided to us.
Independent co-pay assistance foundations have their own rules for eligibility. We have no involvement or influence in independent foundation decision-making or eligibility criteria and do not know if a foundation will be able to help you. We can only refer you to a foundation that supports your disease state. This information is provided as a resource for you. We do not endorse or show preference for any particular foundation. The foundations in this list may not be the only ones that might be able to help you.
If you have financial difficulty or do not have insurance coverage and need help affording Esbriet, this program may help:
Legacy Patient Program
The Legacy Patient Program gives free Esbriet to people who have been prescribed this medicine and don’t have insurance or that have financial concerns and meet certain eligibility criteria.
You may be eligible if your insurance coverage and income match one of these situations:
- Uninsured patients with incomes under $150,000*
- Insured patients without coverage for Esbriet with incomes under $150,000*
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Insured patients with
coverage for a Legacy Pharma
Inc. SEZC
medicine*†:
- With an out-of-pocket maximum set by their health insurance plan that exceeds 7.5% of their household income
-
With household size and
income within certain
guidelines outlined
below:
Legacy Patient Program eligibility depends on your health insurance and financial situation. You may qualify if you are in 1 of the 3 groups below:
“I have no insurance”
For a household of 1-4 people, total yearly income is under $150,000*.
*For households with more than 4 people, add $25,000 to the yearly income for each additional person.
“I have insurance, but it doesn’t cover Esbriet”
“I have insurance that covers Esbriet, but the out-of-pocket maximum set by my health insurance plan is more than 7.5% of my yearly income”
Household Size
Yearly Income
1 person
Under $75,000
2 people
Under $100,000
3 people
Under $125,000
4 people
Under $150,000
For households with more than 4 people, add $25,000 to the yearly income limit for each additional person.
Not sure if you are Eligible? Call 1-855-518-7562 to speak with a Program Specialist.
†We encourage insured patients to try other financial assistance options before applying for help from the Legacy Patient Program, if possible.
Enrollment Process for the Legacy Patient Program
To get started:
- Complete the Program Enrollment Form, which is available in English and Spanish, below:
- Once you have completed the first two sections of the Patient Enrollment Form, please take the partially completed form to your prescriber who will need to fill out the rest of the form before we can help you.
Alternatively, you can enroll in the Legacy Patient Program by filling out the online forms available through the link below:
What to expect next:
- The request will be processed within five business days upon receipt of the required form.
- You and your provider will be contacted to discuss the application outcome and any next steps.
If you have any questions about the criteria, please contact a Program Specialist at 1-855-518-7562 (Mon.–Fri., 9AM–6PM EST).
Legacy Pharma Inc. SEZC reserves the right to modify or discontinue the program at any time and to verify the accuracy of information submitted.
Tips & Helpful Links
Find information about nutrition, exercise and resources for people living with IPF.
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Commercial insurance: An insurance plan you get from a private health insurance company. This can be insurance from your job, from a plan you bought yourself or from a Health Insurance Marketplace. Medicare and Medicaid are not considered commercial insurance.
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Public insurance: A health insurance plan you get from the federal or state government. This includes Medicare, Medicaid, TRICARE and DoD/VA insurance.
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For example, a household size of 1 with income of less than $75,000 may meet the criteria for assistance. Add $25,000 for each additional person in the household. There is no maximum number of people you may add.
Terms and Conditions
The Co-pay Program (“Program”) is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Legacy Pharma Inc. SEZC medicine. The Program is not available to patients whose prescriptions are reimbursed under any federal, state, or government-funded insurance programs (included but not limited to Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs Programs) or where prohibited by law or by the patient's health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare programs, the patient will no longer be eligible for the Program. The Program is not valid for Legacy Pharma Inc. SEZC medicines that are eligible to be reimbursed in their entirety by private insurance plans or other programs.
Under the Program, the patient may be required to pay a co-pay. The final amount owed by a patient may be as little as $0 for the Legacy Pharma Inc. SEZC medicine (see Program specific details available on the Program Website). The total patient out-of-pocket cost is dependent on the patient’s health insurance plan. The Program assists with the cost of the Legacy Pharma Inc. SEZC medicine only. It does not assist with the cost of other medicines, procedures or office visit fees. After reaching the maximum annual Program benefit amount, the patient will be responsible for all remaining out-of-pocket expenses. The Program benefit amount cannot exceed the patient’s out-of-pocket expenses for the Legacy Pharma Inc. SEZC medicine. The maximum Program benefit will reset every January 1st. The Program is not health insurance or a benefit plan. The patient’s non-governmental insurance is the primary payer. The Program does not obligate the use of any specific medicine or provider. Patients receiving assistance from charitable free medicine programs (such as the Legacy Patient Program) or any other charitable organizations for the same expenses covered by the Program are not eligible. The Program benefit cannot be combined with any other rebate, free trial or other offer for the Legacy Pharma Inc. SEZC medicine. No party may seek reimbursement for all or any part of the benefit received through the Program.
The Program may be accepted by participating pharmacies, physicians’ offices or hospitals. Once a patient is enrolled, the Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days. Claims must be submitted within 365 days from the date of service unless otherwise indicated. Use of the Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physicians’ offices and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Programs’ benefits may not be sold, purchased, traded or offered for sale.
The patient or their guardian must be 18 years of age or older to receive Program assistance. The Program is only valid in the United States and U.S. Territories, is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Eligible patients will be automatically re-enrolled in the Program on an annual basis each January 1st. Eligible patients will be removed from the Program after 3 years of inactivity (e.g., no claims submitted in a 3-year timeframe). Patients who choose reimbursement via virtual debit card will have access to the patient’s funds as long as the patient's virtual debit card is valid and the patient is active in the Program. Once a patient's virtual debit card has expired and they are no longer active in the program, the funds will be removed from the virtual debit card. Program eligibility and automatic re-enrollment are contingent upon the patient’s ability to meet all requirements set forth by the Program. Healthcare providers may not advertise or otherwise use the Program as a means of promoting their services or Legacy Pharma Inc. SEZC medicines to patients.
The value of the Program is intended exclusively for the benefit of the patient. The funds made available through the Program may only be used to reduce the out-of-pocket costs for the patient enrolled in the Program. The Program is not intended for the benefit of third parties, including without limitation third party payers, pharmacy benefit managers, or their agents. If Legacy Pharma Inc. SEZC determines that a third party has implemented a program that adjusts patient cost-sharing obligations based on the availability of support under the Program and/or excludes the assistance provided under the Program from counting towards the patient’s deductible or out-of-pocket cost limitations, Legacy Pharma Inc. SEZC may impose a per fill cap on the cost-sharing assistance available under the Program. Submission of true and accurate information is a requirement for eligibility and Legacy Pharma Inc. SEZC reserves the right to disqualify patients who do not comply with Legacy Pharma Inc. SEZC Program Terms and Conditions. Legacy Pharma Inc. SEZC reserves the right to rescind, revoke or amend the Program without notice at any time.