The Chiesi Total Care Program Assists Patients With:

Dedicated Total Care Team

  • Pharmacists
  • Patient Service Coordinators (PSCs)
  • Reimbursement Support Specialists
  • Nursing support

Injection support

  • Ensures medication is delivered right to where your patients need it
  • Answers questions about administration, storage and disposal, and more

Commercial insurance

If your patients have private insurance through their job or their own business

Government insurance

If your patients have Medicare, Medicaid, Veterans Affairs Healthcare, or other similar government insurance

No insurance

If your patients have no insurance, they may be eligible for financial assistance

Chiesi Total Care Patient Assistance Program

Your Patients May Be Eligible to Receive Your Medication at No Cost

Patients who meet the financial requirements of the Chiesi Total Care Patient Assistance Program may be eligible to receive your medication at no cost.

Program Eligibility:

  • Patient enrolled in Chiesi Total Care. (Enrollment form can be found here)
  • Patient has a valid prescription for a US Food and Drug Administration (FDA)-approved indication for Revcovi®
  • Patient does not receive health care benefits from a federal or state-funded plan or program
  • Patient is uninsured or underinsured (lack of coverage for their medication)
  • If patient has commercial insurance, they may be eligible for the Chiesi Total Care Copay Assistance Program
  • Patient must have an annual household income that does not exceed 500% of the current Federal Poverty Level (FPL)*
  • Patient must be a resident of the United States or one of its territories

*Please refer to the full Terms and Conditions for additional eligibility requirements.

Prescription Order Form

Please fax completed form to Chiesi Total Care staff at 1-866-272-7079.
Please call 1-866-272-7078 if you have questions regarding this form, or contact Chiesi Total Care.

For more information about Revcovi, visit revcovi.com.
Revcovi® (elapegademase-lvlr)

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

  • Injection site bleeding in patients with thrombocytopenia: Increased risk of local bleeding in patients with thrombocytopenia; should not be used if thrombocytopenia is severe.
  • Delay in improvement of immune function: Protect immune deficient patients from infections until improvement in immune function.

ADVERSE REACTIONS

The most commonly reported adverse reactions were cough (50%) and vomiting (33%).

In addition, the following post-marketing reports for the same class of enzyme replacement therapy used in the treatment of ADA-SCID may also be seen with Revcovi treatment:

  • Hematologic events: hemolytic anemia, autoimmune hemolytic anemia, thrombocythemia, thrombocytopenia and autoimmune thrombocytopenia
  • Dermatological events: injection site erythema, urticaria
  • Lymphomas

IMPORTANT MONITORING INFORMATION

Treatment with Revcovi should be monitored by measuring trough plasma ADA activity and trough dAXP levels for maintenance of therapeutic targets. If a persistent decline in plasma ADA activity occurs, immune function and clinical status should be monitored closely, and precautions should be taken to minimize the risk of infection.

INDICATION

Revcovi® (elapegademase-lvlr) is indicated for the treatment of adenosine deaminase severe combined immune deficiency (ADA-SCID) in pediatric and adult patients.

Please see Full Prescribing Information.

IMPORTANT SAFETY INFORMATION

WARNINGS AND PRECAUTIONS

  • Injection site bleeding in patients with thrombocytopenia: Increased risk of local bleeding in patients with thrombocytopenia; should not be used if thrombocytopenia is severe.
  • Delay in improvement of immune function: Protect immune deficient patients from infections until improvement in immune function.

ADVERSE REACTIONS

The most commonly reported adverse reactions were cough (50%) and vomiting (33%).

In addition, the following post-marketing reports for the same class of enzyme replacement therapy used in the treatment of ADA-SCID may also be seen with Revcovi treatment:

  • Hematologic events: hemolytic anemia, autoimmune hemolytic anemia, thrombocythemia, thrombocytopenia and autoimmune thrombocytopenia
  • Dermatological events: injection site erythema, urticaria
  • Lymphomas

IMPORTANT MONITORING INFORMATION

Treatment with Revcovi should be monitored by measuring trough plasma ADA activity and trough dAXP levels for maintenance of therapeutic targets. If a persistent decline in plasma ADA activity occurs, immune function and clinical status should be monitored closely, and precautions should be taken to minimize the risk of infection.

INDICATION

Revcovi® (elapegademase-lvlr) is indicated for the treatment of adenosine deaminase severe combined immune deficiency (ADA-SCID) in pediatric and adult patients.

Please see Full Prescribing Information.