Copay Assistance Program Terms and Conditions

The Kiniksa Pharmaceuticals Copay Assistance Program (the “Program”) can offer eligible patients savings on their prescriptions for Kiniksa medicine.
 
Eligibility Requirements:
  • The patient has commercial prescription drug insurance that covers the medicine.
    • The Program is not available for patients whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, such as patients enrolled in Medicare Part D and patients whose prescription is paid for by Medicare, Medicaid, Medigap, CHAMPUS, Department of Defense (DoD), TRICARE, Veterans Affairs (VA), Children’s Health Insurance Program (CHIP), the Indian Health Service, or any other federal or state pharmaceutical assistance program.
    • The Program is not available if a patient is uninsured or paying cash for the medicine.
    • This Program is not available if the commercial prescription drug insurance reimburses for the entire cost of the medicine.
  • The patient lives in the U.S. or a U.S. territory.
  • The patient has a valid prescription for the medicine for an FDA-approved indication.
 
Where reimbursement covers a portion of the prescription, the Program is valid only for the amount of the actual out-of-pocket cost (up to $25,000 in total cost-sharing assistance per calendar year for those patients accessing the product under a pharmacy benefit). The Program is not health insurance, and it may not be combined with any other program, rebate, coupon, or offer. No claim for reimbursement for all or any part of the benefit received by the patient through the Program may be submitted to anyone, including any insurance source. The Program is intended for the sole benefit of eligible patients and may not be utilized for the benefit of third parties, including, without limitation, third-party payers, pharmacy benefit managers, or the agents of either.
 
The Kiniksa OneConnect™ team will evaluate and determine if a patient is eligible for the Program. The Program may not apply in certain states.
 
Additional eligibility requirements and program terms and conditions apply. Kiniksa Pharmaceuticals reserves the right to rescind, revoke, or amend the Program or reduce the cost-sharing assistance available under the Program at any time without notice, including where Kiniksa Pharmaceuticals has determined that an eligible patient’s insurer has implemented (i) a “co-pay maximizer program,” which adjusts an eligible patient’s cost-sharing obligations based on the availability of support under the Program, or (ii) an “accumulator adjustment program,” which excludes the financial assistance provided under the Program from counting towards an eligible patient’s deductible or out-of-pocket cost limitations. Eligible patients enrolled in the Program must contact the Kiniksa OneConnect™ team at 1-833-KINIKSA (1-833-546-4572) if their insurer implements a co-pay maximizer program or accumulator adjustment program. In such cases, the Kiniksa OneConnect™ team will determine if other cost-sharing assistance is available.
 
Contact the Kiniksa OneConnect™ team at 1-833-KINIKSA (1-833-546-4572) for additional information.

 

Effective May 17, 2024