Savings Program

CO-PAY*

|

May lower patient out-of-pocket to $0 for a monthly prescription†

Patient Support

Give your patients the support they need

With the MyAmpyra Patient Support Program, your patients get:

  • Personal, 1-to-1 service
  • Insurance support: Benefit investigation determines eligibility for co-pay assistance and connects the patient with a specialty pharmacy that will deliver AMPYRA to your patient's door.
  • Co-pay assistance: Patients with commercial insurance may be eligible for assistance with their co-pay from Merz. Restrictions apply.*,†
*Patients who participate in Medicaid, Medicare, or any other federal healthcare program are not eligible to receive co-pay assistance. Co-pay assistance is provided up to $1,000 per month per person, with a maximum annual cap of $12,000. See full Terms & Conditions
Terms and Conditions

Patients must:

  • Be 18 years of age or older
  • Be prescribed AMPYRA for an FDA-approved indication
  • Have commercial health insurance
  • Not covered by any federal, state, or government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Veterans Affairs, Department of Defense, or TRICARE

This offer is valid only in the United States, excluding where it’s otherwise prohibited by law. Patients residing in the states of Massachusetts and Rhode Island are eligible for drug co-payment assistance only and are not eligible for other types of co-payment assistance.

Patients who move from commercial to federally funded or state funded insurance will no longer be eligible for the program. Proof required for receiving payment for out-of-pocket drug costs includes a valid explanation of benefits (EOB) or specialty pharmacy invoice, which must be submitted within 180 days after each treatment.

Patient/Guardian may not and agrees not to seek reimbursement for value received from the Program from any third-party payers, including flexible spending accounts or healthcare savings accounts. If at any time patient begins receiving coverage under any federal, state, or government-funded healthcare program, Patient is no longer eligible to participate in the Program and must call 1-855-866-9255 between 8am – 8pm ET to stop participation. Restrictions may apply. This is not health insurance.

Patient/Guardian and pharmacist are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using the Program as may be required by the insurance carrier’s terms and conditions and applicable law.

Once a patient is successfully enrolled into the Program, they will be automatically re-enrolled annually, for as long as your patient remains eligible. The patient is obligated to notify the program within thirty (30) days of any change in information provided in patient’s enrollment form. The patient may notify the Program at any time to terminate participation in the Program. The patient may submit a new enrollment form to make changes to any Program elections. This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer for AMPYRA.

This is a limited time offer, and Merz reserves the right to rescind, revoke, amend, or terminate this offer, or the program in its entirety, at any time without notice.

Patient Assistance Program

For information about the eligibility requirements of the Merz Patient Assistance Program, call 1-855-866-9255.
†Please note, restrictions and maximum benefits apply to the co-pay assistance program. For more information, call 1-855-866-9255. Merz may modify these maximums or discontinue the program at any time. In this case, any change to what commercial patients are required to pay will be communicated to patients by their specialty pharmacy. The actual amount patients have to pay will vary depending upon these maximums and their insurance benefit.
See more

Indication

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg, is indicated to improve walking in adults with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.

Important Safety Information

AMPYRA is contraindicated in patients with history of seizure, moderate or severe renal impairment (CrCl ≤ 50 mL/min), or history of hypersensitivity to AMPYRA or 4-aminopyridine.

Indication

AMPYRA® (dalfampridine) Extended Release Tablets, 10 mg, is indicated to improve walking in adults with multiple sclerosis (MS). This was demonstrated by an increase in walking speed.

Important Safety Information

  • AMPYRA is contraindicated in patients with history of seizure, moderate or severe renal impairment (CrCl ≤ 50 mL/min), or history of hypersensitivity to AMPYRA or 4-aminopyridine.
  • AMPYRA can cause seizures. The risk of seizures increases with increasing doses. Permanently discontinue AMPYRA if seizure occurs. In the post-marketing period seizures have been reported. The majority of seizures occurred at the recommended dose, in patients without a history of seizures, and generally within days to weeks of starting therapy.
  • AMPYRA has not been evaluated in patients with history of seizures or with epileptiform activity on an EEG, as these patients were excluded from clinical trials. The risk of seizures in patients with epileptiform activity on an EEG is unknown, and could be substantially higher than that observed in clinical studies.
  • Avoid concomitant use of AMPYRA with other forms of 4-aminopyridine (4-AP, fampridine), since the active ingredient is the same. Instruct patients to discontinue use of any product containing 4-AP prior to initiating AMPYRA to reduce the potential for dose-related adverse reactions.
  • AMPYRA can cause anaphylaxis and severe allergic reaction. Signs and symptoms included respiratory compromise, urticaria, and angioedema of the throat or tongue. If an anaphylactic or other serious allergic reaction occurs, permanently discontinue AMPYRA.
  • AMPYRA is cleared predominantly by the kidneys. The risk of seizures in patients with mild renal impairment (CrCl 51–80 mL/min) is unknown, but AMPYRA plasma levels in these patients may approach those seen at a dose of 15 mg twice daily, a dose that may be associated with an increased risk of seizures. Estimated CrCl should be known before initiating AMPYRA and monitored at least annually during treatment.
  • The most common adverse reactions (incidence ≥ 2% and at a rate greater than placebo) for AMPYRA in MS patients were urinary tract infection, insomnia, dizziness, headache, nausea, asthenia, back pain, balance disorder, MS relapse, paresthesia, nasopharyngitis, constipation, dyspepsia, and pharyngolaryngeal pain.
  • The risk of adverse reactions, including seizures, increases with increasing AMPYRA doses. There is no evidence of additional benefit at doses greater than 10 mg twice daily.
  • Concomitant use with OCT2 inhibitors (e.g., cimetidine) may cause increased exposure to AMPYRA and potential risk of seizures.
  • There are no adequate data on AMPYRA in pregnant women. Based on animal data, use of AMPYRA during pregnancy may cause fetal harm.
  • There are no data on presence of AMPYRA in breastmilk; benefits of breastfeeding should be considered along with benefit of AMPYRA to the mother and potential risks to the infant.
  • Safety and effectiveness of AMPYRA in patients younger than 18 years have not been established.
  • Clinical studies of AMPYRA did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Because elderly patients are more likely to have decreased renal function, it is important to know the estimated CrCl before initiating AMPYRA.

Please see the Full Prescribing Information.