This acts as your prescription for
AUBAGIO and allows you to enroll in MS One to One Support Services.*
A few days after your doctor completes your Start Form, your dedicated MS One to One Nurse will call you to confirm all the information on this form, review your insurance coverage, and discuss available financial assistance, including the AUBAGIO Co-Pay Program† for eligible patients with commercial insurance.
You can expect to receive this call
Soon afterward, you should receive a call from your Specialty Pharmacy to set up delivery of AUBAGIO. They’ll help make sure that AUBAGIO is delivered to your home, and also help you manage AUBAGIO refills.
*MS One to One is an optional service available to you.
†Out-of-pocket costs related to medication, appointments, evaluations, testing, or other related services are not covered by the AUBAGIO Co-Pay Program. The AUBAGIO Co-Pay Program is not available for prescriptions purchased under Medicare, Medicaid, TRICARE, or other federal- and state-funded programs. Sanofi reserves the right to amend or terminate the Program at any time without notice. The maximum annual patient benefit under the AUBAGIO Co-Pay Program is $18,000. Co-pay amounts after applying co-pay assistance may depend on the patient’s insurance plan and may vary. The AUBAGIO Co-Pay Program is intended to help patients afford AUBAGIO. Patients may have insurance plans that attempt to dilute the impact of the assistance available under the AUBAGIO Co-Pay Program. In those situations, the AUBAGIO Co-Pay Program may change its terms.
AUBAGIO® (teriflunomide) is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
Are of childbearing potential and not using effective birth control.
It is not known if AUBAGIO passes into breast milk. Your healthcare provider can help you decide if you should take AUBAGIO or breastfeed — you should not do both at the same time.
If you are a man whose partner plans to become pregnant, you should stop taking AUBAGIO and talk with your healthcare provider about reducing the levels of AUBAGIO in your blood. If your partner does not plan to become pregnant, use effective birth control while taking AUBAGIO.
AUBAGIO may stay in your blood for up to 2 years after you stop taking it. Your healthcare provider can prescribe a medicine that can remove AUBAGIO from your blood quickly.
Before taking AUBAGIO, talk with your healthcare provider if you have: liver or kidney problems; a fever or infection, or if you are unable to fight infections; numbness or tingling in your hands or feet that is different from your MS symptoms; diabetes; serious skin problems when taking other medicines; breathing problems; or high blood pressure. Your healthcare provider will check your blood cell count and TB test before you start AUBAGIO. Talk with your healthcare provider if you take or are planning to take other medicines (especially medicines for treating cancer or controlling your immune system), over-the-counter medicines, vitamins or herbal supplements.
AUBAGIO may cause serious side effects. Tell your doctor if you have any of the following:
The most common side effects when taking AUBAGIO include: headache; diarrhea; nausea; hair thinning or loss; and abnormal liver test results. These are not all the side effects of AUBAGIO. Tell your healthcare provider about any side effect that bothers you.
Consult your healthcare provider if you have questions about your health or any medications you may be taking, including AUBAGIO.
IMPORTANT SAFETY INFORMATION
Do not take AUBAGIO if you have severe liver problems. AUBAGIO may cause serious liver problems, including liver failure that can be life-threatening and may require a liver transplant. View More