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With the ILUMYA^® Copay Program, eligible patients with commercial insurance may pay as little as $0* for ILUMYA^®. If you do not qualify for the copay card, there may still be savings options available to you—like the Early Access Program.

With the ILUMYA^® Copay Program, eligible patients with commercial insurance may pay as little as $0* for ILUMYA^®. If your patient does not qualify for the copay card, there may still be savings options available to them—like the Early Access Program.

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I am 18 years of age or older and a permanent resident of the United States or a United States territory. My patient is 18 years of age or older and is a permanent resident of the United States or a United States territory.

Yes

You must be 18 years of age or older to participate in the ILUMYA^® Copay Program.

The patient must be 18 years of age or older to participate in the ILUMYA^® Copay Program.

I have commercial (also known as private) insurance coverage. This includes insurance from an employer or from a health insurance marketplace. Does the patient have commercial (also known as private) insurance coverage? This includes insurance from an employer or from a health insurance marketplace.

Yes

We’re sorry; your response indicates that you are not eligible for the ILUMYA^® Copay Program. Please call the ILUMYA^® Copay Program at 1-866-253-6677 to see if other financial support options may apply.

We’re sorry; your response indicates that your patient is not eligible for the ILUMYA^® Copay Program. Please call the ILUMYA^® Copay Program at 1-866-253-6677 to see if other financial support options may apply.

I am using a federal or state-funded health insurance program to pay for my treatment of ILUMYA^®. This includes, but is not limited to, Medicare, Medicaid, Medigap, Veteran’s Affairs (VA), Department of Defense (DoD), TRICARE, Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”), or any other federal or state government program. Is the patient using a federal or state-funded health insurance program to pay for their treatment of ILUMYA^®? This includes, but is not limited to, Medicare, Medicaid, Medigap, Veteran’s Affairs (VA), Department of Defense (DoD), TRICARE, Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”), or any other federal or state government program.

Yes

I am currently receiving the product for free through the ILUMYA^® Patient Assistance Program. Is the patient currently receiving the product for free through the ILUMYA^® Patient Assistance Program?

Yes

We’re sorry; your response indicates that you are not eligible for the ILUMYA^® Copay Program.

We’re sorry; your response indicates that your patient is not eligible for the ILUMYA^® Copay Program.

I acknowledge and agree that any of the information disclosed during enrollment, including any patient information, contact information, demographic information, and information related to my medical condition, treatments, and health insurance and benefits, will be shared with Sun Pharmaceuticals, Inc., its affiliates, service providers and other vendors (collectively "Sun Pharmaceutical Industries Limited"). In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by ILUMYA^® will also be shared. I authorize Sun Pharmaceutical Industries Limited, to receive, use, and share my personal information in connection with the ILUMYA^® Copay Program. I agree to be contacted by phone, mail or email about the ILUMYA^® Copay Program. For more information, please see Sun Pharmaceutical Industries Limited’s Privacy Policy at https://sunpharma.com/privacy-policy-new/. I acknowledge and agree on behalf of myself and the patient that any of the information disclosed during enrollment, including any patient information, contact information, demographic information, and information related to the patient's medical condition, treatments, and health insurance and benefits, will be shared with Sun Pharmaceuticals, Inc., its affiliates, service providers and other vendors (collectively "Sun Pharmaceutical Industries Limited"). In addition, information shared by the pharmacy/physician, such as the date the prescription was filled, the date the medication was administered by the physician (if applicable) and the amount that will be reimbursed by ILUMYA^® will also be shared. I authorize Sun Pharmaceutical Industries Limited, on behalf of the patient, to receive, use, and share the patient's personal information in connection with the ILUMYA^® Copay Program. I agree to be contacted by phone, mail or email about the ILUMYA^® Copay Program. For more information, please see Sun Pharmaceutical Industries Limited's Privacy Policy at https://sunpharma.com/privacy-policy-new/.

Yes

You must agree to the above terms to participate in ILUMYA^® Copay Program.

Your patient must agree to the above terms to participate in ILUMYA^® Copay Program.

I certify that I have accessed and reviewed the full Program Terms and Conditions by visiting https://www.ilumya.com/savings. I certify that I have accessed and reviewed the full Program Terms and Conditions with the patient by visiting https://www.ilumya.com/savings.

Yes

Please use the link to access and review the full Program Terms and Conditions if you wish to participate in ILUMYA^® Copay Program.

If your patient would like to participate in ILUMYA^® Copay Program, please use the link to access and review the full Program Terms and Conditions to continue the enrollment.

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