Additional Resources | ENHERTU4U (fam-trastuzumab deruxtecan-nxki) 20 mg/ml Injection for Intravenous Use

Frequently asked
questions

My co-pay for ENHERTU is too high. How can you help me?

The ENHERTU Patient Savings Program is available for commercially insured patients. The goal of the program is to remove cost as a barrier for eligible commercial patients by assisting with their out-of-pocket costs for ENHERTU. Talk to your doctor to sign up for the program or call ENHERTU4U at 1-833-ENHERTU (1-833-364-3788).

I cannot afford ENHERTU. What are my options?

There may be options to help you get ENHERTU. ENHERTU4U can refer you to patient assistance options such as the patient savings program, Patient Assistance Programs (PAP), and independent foundations.

Explore Your Options

My health plan denied coverage for ENHERTU

We have resources to help your doctor file an appeal. Your doctor’s office will need to file an appeal directly with your health plan. Have your doctor visit ENHERTU4U.com or call 1-833-ENHERTU (1-833-364-3788).

I no longer have or do not have health insurance. What do I do?

If you cannot afford your medicine, you may be able to get help from our Patient Assistance Programs (PAP). PAP can provide ENHERTU for free if you qualify. Eligibility rules apply. Please click here for more information regarding eligibility.

Key terms

To understand insurance coverage, the following key terms will be helpful.

Brand-name drugs

Drugs marketed under a trade name by the manufacturer that develops and patents them.

Generic drugs

Once the patent (or license) expires on a brand-name drug, a generic chemically equivalent version can be developed and sold at a lower cost.

Premium

Payments made by patient to maintain insurance coverage. This is a monthly payment and varies by insurance plan.

Co-payments (Co-pays)

The set fee patients pay for a covered service every time that service is provided. Co-payments vary depending on the plan. Co-payments do not count toward a deductible but do count toward the annual out-of-pocket maximum for most services. Nearly all plans have co-payments or co-insurance.

Co-insurance

The percentage of the cost the patient pays for a covered service. Co-insurances vary according to the plan and do not apply toward deductibles. However, they do count toward the annual out-of-pocket maximum for most services.

Deductible

The set amount patients must pay each contract year for covered medical services before the insurance plan begins to pay its share. Patients with a deductible will be billed for the full allowable amount for each service that is subject to the deductible.

Common types of
insurance coverage

There are two types of health insurance, private and public. Private, or “commercial” health insurance is insurance you get from your job, or insurance you buy directly from an insurance company or exchange.

Public health insurance is provided by the federal or state government. This includes Medicare, Medicaid, Veterans Health Administration/TRICARE Department of Defense.

Private and public health insurance both include the medical benefit and the pharmacy benefit.

Medical benefit

Typically covers physician and hospital services for things like visits to the doctor, drugs administered by doctors, hospital services and supplies, and some home health services.

Pharmacy benefit

Typically covers prescription drugs taken by mouth, and self-administered injectable prescription drugs that are used at home.

Understanding Medicare

Medicare mainly provides coverage for people who are over the age of 65, blind, or disabled. This program pays for medical services and procedures that have been determined as “reasonable and necessary.” It is important to note that there are various parts of Medicare and benefits vary based on the type of coverage you select.

Medicare Part A
Hospital Insurance

Covers inpatient hospital services and certain follow-up care.

Medicare Part B
Medical Insurance

Covers medically necessary services and supplies. Also covers drugs prescribed and administered by a healthcare provider.

Medicare Part C
Medicare Advantage

Covers part A and part B benefits, and could also include prescription coverage.

Medicare Part D
Medicare Prescription Drug Coverage

These are private insurance plans specifically for prescription drug coverage.

Medicaid

Covers people with low incomes and some disabled people. Funded partly by the federal government and partly by individual states.

Veterans Health Administration/TRICARE DoD (Department of Defense)

Covers people who are or have been in the military, including:

Veterans
Active-duty service members
National Guard and Reserve members
Retirees
Families of retirees

Patient Authorization
Form

In order for you to receive ENHERTU4U program offerings, your doctor will complete an enrollment form. If you did not sign this form at your doctor’s office, you can give authorization in 1 of 3 ways:

Call ENHERTU4U at 1-833-ENHERTU (1-833-364-3788) to give authorization over the phone
Print the form below and fax it to 1-866-760-5917
Provide completed form to your doctor and they will send it to ENHERTU4U