For GA, secondary to AMD

NAVIGATING FINANCIAL ASSISTANCE

Help remove financial 
barriers to SYFOVRE
Smiling woman looking off camera to left

Financial assistance is available for eligible patients with multiple types of insurance, limited coverage, or no insurance.

Co-pay card

Co-pay Programa,b

A program for commercially-insured, eligible patients that assists with co-pay and co-insurance expenses related to the cost of SYFOVRE and its administration.

Learn more about the Co-pay Program
Patient Assistance Program

Patient Assistance Programc

A program providing free product for eligible patients who are uninsured, underinsured, or cannot afford their co-pay.

Learn more about the Patient Assistance Program
Referrals to foundations

Referrals to foundations

ApellisAssist offers referrals to independent assistance foundations for eligible patients who are commercially or government-insured. These independent assistance foundations provide financial assistance to eligible patients, regardless of the treatment they are prescribed.

Apellis has no involvement or influence in independent foundation decision-making or eligibility criteria. Apellis does not endorse or show preference for any particular foundation.

See sources of foundation funding

If financial assistance is needed for your patient, ApellisAssist only requires the completed Enrollment Form to initiate the process.

CLICK HERE TO ENROLL IN APELLISASSIST

aThe SYFOVRE Co-pay Program is for eligible patients who are enrolled in the ApellisAssist program, are commercially insured, and are not covered under government insurance programs such as Medicare, Medicaid, VA/DoD, or TRICARE. Apellis reserves the right to modify or terminate the program at any time without notice.

bThe program assists only with the cost of SYFOVRE and its administration (injection) where permitted, up to the program maximum. It does not assist with the cost of other administrations, medicines, procedures, or office visits. Eligible patients residing in Massachusetts or Rhode Island can only receive assistance with the cost of SYFOVRE but not the cost of its administration. Patients receiving assistance through another program or foundation, free trial, or other similar offer or program, are not eligible for the program.

cProgram eligibility criteria, including annual household income limits, apply. Apellis reserves the right to modify or terminate the program at any time without notice.

Co-pay-icon

Co-pay Program

Eligible patients may pay as little as $0 for each SYFOVRE treatment up to the program’s annual assistance limit

  • The program provides assistance for an eligible patient’s drug and administration out-of-pocket (OOP) costs up to a maximum dollar amount per calendar year
  • Patients may be responsible for additional OOP costs that exceed the limit or for costs that are not directly related to the costs of SYFOVRE and its administration
  • Eligibility Criteria

Patients must:

  • Be enrolled in ApellisAssist
  • Be under the care of a US-licensed physician and prescribed SYFOVRE
  • Have an on-label diagnosis of geographic atrophy secondary to AMD
  • Have commercial insurance
  • The Process

ApellisAssist will screen for co-pay eligibility and inform the eye care professional (ECP) of the approval or denial

  • If ApellisAssist confirms the patient has commercial insurance during the benefits investigation, then the patient is automatically approved and enrolled into the program
  • ApellisAssist will notify your office about the approval via fax and the portal, and provide a patient-specific co-pay ID number that will need to be used when submitting claims for co-pay reimbursement to the Co-pay Program
  • Requests for reimbursement must be submitted within 180 days of the date of service
  • If the co-pay reimbursement request is approved, the ECP will receive payment
  • If the co-pay reimbursement request is denied, the ECP will receive a reimbursement denial letter explaining why the claim was denied
  • Eligible patients will be automatically re-enrolled each calendar year after their benefits and eligibility have been reverified and if there is no change in the patient’s commercial insurance status

Refer to the Co-pay Program Resource below for additional details on the program

DOWNLOADDownload resource
PAP-icon

Patient Assistance Program (PAP)

A program providing free product for eligible patients who are uninsured, underinsured, or cannot afford their co-pay

  • Eligibility Criteria

Note: Filling in section 4.1 of the Enrollment Form helps the ApellisAssist program determine if the patient meets the eligibility criteria. 

Patients must:

  • Be enrolled in ApellisAssist
  • Meet one of the following:
  • Be uninsured (no insurance)
  • Be underinsured (insurance does not cover SYFOVRE)
  • Have insurance that covers SYFOVRE but cannot afford the co-pay
  • Be functionally uninsured (denied coverage by insurance with no pathway to approval)
  • Be under the care of a US-licensed physician and prescribed SYFOVRE
  • Have an on-label diagnosis
  • Meet the financial criteria (household income of <$150,000 or 600% of federal poverty level, whichever is greater)
  • The Process

ApellisAssist will contact the ECP to advise that a patient is eligible for PAP

  • If the ECP and patient choose to move forward with SYFOVRE treatment after enrollment, then ApellisAssist will screen for PAP eligibility and inform the ECP of the approval or denial
  • If approved, the patient is triaged to the noncommercial dispensing pharmacy. Product is provided in one-month increments for up to one calendar year after which re-application is required. For eligible Medicare patients, product will be provided for one calendar year
  • If denied due to financial reasons, patients can qualify for a hardship request determination

Enroll a patient in ApellisAssist and call 888-APELLIS (888-273-5547) 
for eligibility criteria.

Referrals to foundations

Referrals to independent foundations for eligible patients

Financial support may be available through independent third-party organizations such as those listed below.d

Good Days

mygooddays.org

Go to external link

Healthwell

healthwellfoundation.org

Go to external link

Patient Access Network (PAN) Foundation

panfoundation.org

Go to external link

The Assistance Fund (TAF)

tafcares.org

Go to external link

dThese are independent organizations that may provide assistance to eligible patients. This list is not exhaustive. Apellis has no involvement or influence in independent foundation decision-making or eligibility criteria. Apellis does not endorse or show preference for any particular foundation.

Learn how to order SYFOVRE from a specialty distributor or specialty pharmacy.

NAVIGATE TO PRODUCT ACQUISITION

AMD=age-related macular degeneration; DoD=Department of Defense;  GA=geographic atrophy; HIPAA=Health Insurance Portability and Accountability Act; VA=Veteran Affairs.

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IMPORTANT SAFETY INFORMATION 

INDICATION

CONTRAINDICATIONS

  • SYFOVRE is contraindicated in patients with ocular or periocular infections, in patients with active intraocular inflammation, and in patients with hypersensitivity to pegcetacoplan or any of the excipients in SYFOVRE. Systemic hypersensitivity reactions (e.g., anaphylaxis, rash, urticaria) have occurred.

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

WARNINGS AND PRECAUTIONS

  • Endophthalmitis and Retinal Detachments

    • Intravitreal injections, including those with SYFOVRE, may be associated with endophthalmitis and retinal detachments. Proper aseptic injection technique must always be used when administering SYFOVRE to minimize the risk of endophthalmitis. Patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment without delay and should be managed appropriately.

  • Retinal Vasculitis and/or Retinal Vascular Occlusion

    • Retinal vasculitis and/or retinal vascular occlusion, typically in the presence of intraocular inflammation, have been reported with the use of SYFOVRE. Cases may occur with the first dose of SYFOVRE and may result in severe vision loss. Discontinue treatment with SYFOVRE in patients who develop these events. Patients should be instructed to report any change in vision without delay.

  • Neovascular AMD

    • In clinical trials, use of SYFOVRE was associated with increased rates of neovascular (wet) AMD or choroidal neovascularization (12% when administered monthly, 7% when administered every other month and 3% in the control group) by Month 24. Patients receiving SYFOVRE should be monitored for signs of neovascular AMD. In case anti-Vascular Endothelial Growth Factor (anti-VEGF) is required, it should be given separately from SYFOVRE administration.

  • Intraocular Inflammation

    • In clinical trials, use of SYFOVRE was associated with episodes of intraocular inflammation including: vitritis, vitreal cells, iridocyclitis, uveitis, anterior chamber cells, iritis, and anterior chamber flare. After inflammation resolves, patients may resume treatment with SYFOVRE.

  • Increased Intraocular Pressure

    • Acute increase in IOP may occur within minutes of any intravitreal injection, including with SYFOVRE. Perfusion of the optic nerve head should be monitored following the injection and managed as needed.

ADVERSE REACTIONS

  • Most common adverse reactions (incidence ≥5%) are ocular discomfort, neovascular age-related macular degeneration, vitreous floaters, conjunctival hemorrhage.

INDICATION

SYFOVRE® (pegcetacoplan injection) is indicated for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD).

Please see full Prescribing Information for more information