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The first and only treatment for adults with moderate-to-severe Chronic Hand Eczema (CHE)1,2

LEO Pharma offers
access and savings
programs for your
eligible patients
prescribed ANZUPGO

ANZUPGO® BRIDGE PROGRAM*

Commercially insured patients may be eligible to
receive a limited supply of ANZUPGO at no cost if a
coverage determination is pending.

ANZUPGO® COPAY PROGRAM*

Eligible, commercially insured patients may pay as little
as $0 per 30 g tube of ANZUPGO.

Your patients can enroll and download
their digital copay card here.

To get your patients started,
prescribe ANZUPGO to one of
the enhanced services
pharmacies

Download pharmacy list

Following the benefits investigation, your patients’ prescription may be processed by an enhanced services pharmacy or referred to the ANZUPGO® Let's GO™ Support Program for prescription fulfillment.

If your patients need hands-on support, enroll them in the ANZUPGO Let's GO Support Program

Digital enrollment

If you prefer, you may also download, print, and complete the editable PDF Enrollment Form and fax to 1-855-299-8746 or email to info@anzupgoletsgo.com

Download enrollment form

Patients directly enrolled into ANZUPGO Let's GO can also be evaluated for access and savings support from the ANZUPGO Bridge or Copay programs.

ANZUPGO Patient Assistance Program*

For your eligible patients with demonstrated financial need and limited or no prescription coverage, ANZUPGO can be dispensed through the ANZUPGO Let's GO Support Program.

*See full Terms, Conditions, and Eligibility Rules.

To learn more about the support available from an ANZUPGO Let's GO
team member, call 1-855-ANZUPGO (269-8746),
Monday-Friday, 8 ᴀᴍ – 8 ᴘᴍ ET

Help your patients access ANZUPGO

Ready to prescribe ANZUPGO?

Include the key information below to prevent delays in getting your patients started on ANZUPGO:

Remember to include an ICD-10-CM code. There is no approved ICD-10-CM code for CHE. Examples of ICD-10-CM codes that may be used include†:

Atopic dermatitis: L20.89, L20.9
Allergic contact dermatitis: L23.0-L23.9
Irritant contact dermatitis: L24.0-L24.B3
Protein contact dermatitis: L25.0-L25.9
Acute, recurrent vesicular (dyshidrosis): L30.1
Hand dermatitis: L30.8

ANZUPGO Rx Instructions resource

Download Rx Instructions

ICD-10-CM=International Classification of Diseases, 10th Revision, Clinical Modification; TCS=topical corticosteroids.

†The coding information in this resource is provided for informational purposes only and is subject to change. The ICD-10-CM codes listed may not apply to all patients or to all health plans; it is the responsibility of the healthcare provider to select the appropriate ICD-10-CM code(s) and submit claims that accurately reflect the services and products furnished to a specific patient.

Need to request a medical exception or submit a prior authorization for ANZUPGO?

Support is available to help you and your office staff identify and understand different payer process requirements across various insurance plan types, so you can accurately respond to prior authorizations (PAs) and denials.

Be sure to include:

  • Patient’s age: The patient must be 18 years or older.1
  • Diagnosis: ANZUPGO is indicated for adults with moderate-to-severe Chronic Hand Eczema (CHE).1
  • Example ICD-10-CM code(s): See a list of example codes above
  • Step-through therapy: Typically, a 4-week trial of a topical corticosteroid (TCS) and/or a topical calcineurin inhibitor (TCI) within the past year. Document tried/failed or unacceptable therapies and associated side effects. Include duration of use and discontinuation dates.3
  • Not used in combination: Confirm ANZUPGO will not be used with3:
    • Other JAK inhibitors (including topicals)
    • Potent immunosuppressants
  • Chronicity and severity of condition:
    • Chronicity: CHE >3 months or relapsed ≥2x within a year3
    • Severity: If available, include results of an outcome measure used to document the severity of your patient’s CHE.1
  • Chart notes: Ensure above information is documented for each patient prescribed ANZUPGO. Some plans will require a copy of the chart notes.
Download Sample Letter of Medical Exception and Medical Necessity

Medical Exception and Medical Necessity Checklist

Refer to this checklist when preparing a letter of medical exception and/or medical necessity to submit to your patient’s health insurance plan.

Download Checklist

Prior Authorization Checklist

Refer to this checklist when preparing a prior authorization submission to your patient’s health insurance plan.

Download PA Checklist

PA denied? Here’s what to do next:

  • Determine the reason for the denial
  • Find out the time frame for submitting an appeal
  • Contact the health plan directly to obtain information on its appeals process
Download Sample Letter of Appeal

Appeal Checklist

Refer to this checklist if a request for coverage of ANZUPGO is denied and an appeal is appropriate.

Download Appeal Checklist

Before & after images

See the difference that ANZUPGO made in the hands of these patients

Before and After images

Rapid, powerful efficacy

See results from the rigorous 16-week studies

Efficacy

AS LITTLE AS $0

For eligible patients*

WITH COPAY
SAVINGS →