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Enroll your patients in VELTASSA K+onnect today
VELTASSA K+onnect makes getting started easier
You may get patients started right away by submitting a completed Starter Rx form with prescription...then we will help coordinate the next steps
Enroll in VELTASSA K+onnect
Free trial supply (up to 20 days) available upon HCP request for patients prescribed VELTASSA for the treatment of hyperkalemia*
Assess need and potential eligibility for financial support based on patient’s insurance coverage
Specialty pharmacy provider ships prescription directly to patient
Patient support programs
*VELTASSA Start Program not contingent on purchase. No guarantee VELTASSA will be approved by patient's health plan.
VELTASSA K<sup class="plus">+</sup>onnect practice insights to avoid delays
BEFORE SUBMITTING THE STARTER Rx FORM
- Complete the entire form, including the prescription information section
- Enter the number of refills, as applicable
- Specify the dosage
- Sign and date the form*
- Check the form for completeness and accuracy
- Before sending your patients for lab tests, consider proactively obtaining a patient signature on the Starter Rx form; this can ensure access to patient services in the future, if necessary
You can also visit www.VELTASSAKonnect.com to enroll your patient electronically. Watch the video to learn more.
BEFORE YOUR PATIENT LEAVES THE OFFICE
- Inform the patient that VELTASSA will be shipped directly to their preferred location in refrigerated packaging
- Tell your patient about the welcome call from VELTASSA K+onnect
- Direct your patient to call VELTASSA K+onnect to schedule delivery of the welcome kit and free starting supply of VELTASSA
- VELTASSA K+onnect will contact patients who do not call proactively
- If they miss our call, patients must call back immediately so the starting supply of VELTASSA can be shipped
When possible, have the patient or patient's legal representative review and sign the Starter Rx form. If they are unable to sign the Starter Rx form, VELTASSA K+onnect will contact them directly. They may also visit www.VELTASSAeconsent.com to provide their authorization electronically.
VELTASSA K<sup class="plus">+</sup>onnect makes getting started easier
VELTASSA START PROGRAM
VELTASSA Start Program
Provides the patient with a FREE trial supply of up to 20 days of VELTASSA
- Enroll a new patient with hyperkalemia, based on your judgment of medical necessity, by checking “yes” in the VELTASSA Start Program section of the Starter Rx form
VELTASSA Start can be delivered to the following locations:
- The patient’s home
- The HCP’s office
- Another facility, such as a dialysis center
- The VELTASSA Start Program is not contingent on purchase. There is no guarantee VELTASSA will be approved by the patient’s health plan. The free trial program is based on enrollment in VELTASSA K+onnect and is provided before insurance coverage is determined
When possible, patients should proactively call VELTASSA K+onnect at 1-844-870-7597 and dial 0 to schedule delivery of their welcome kit and free starter supply of VELTASSA. Just write “Phone Enrollment” at the top of the Starter Rx form.
If not, VELTASSA K+onnect will contact them directly. The starter supply of VELTASSA cannot be shipped until the patient returns the call to VELTASSA K+onnect.
- The Starter Rx form is all you need to get started in one step
- Components include insurance information, prescription, and patient authorization
- VELTASSA K+onnect can provide support to patients in more than 200 languages; simply specify preferred language on the Starter Rx form
- You submit the form; we will help coordinate next steps*
VELTASSA K+onnect will inform the HCP's office if the patient's health plan requires additional documentation, if applicable.
VELTASSA K<sup class="plus">+</sup>onnect services can help patients gain access to therapy
$25 CO-PAY PROGRAM
- Eligible patients with commercial insurance may qualify for a coupon program that could reduce their co-pay to no more than $25 a month
- No print coupon required
- Savings are automatically applied
- Patients enrolled in a government healthcare prescription drug program such as Medicare Part D or Medicaid are not eligible for the $25 Co-pay Program. This includes the period when patients are in the Medicare Part D coverage gap known as the "donut hole"
- Services subject to terms and conditions. Please contact VELTASSA K+onnect for more information
- Co-pay Program enrollment is available through VELTASSA K+onnect or certain pharmacies
- To find a participating pharmacy, visit http://evoucherrx.relayhealth.com/storelookup
PATIENT ASSISTANCE PROGRAM
- Patients who are uninsured or underinsured with financial need may be eligible to receive free medication
- Available to eligible patients who are enrolled in VELTASSA K+onnect
- Financial documentation is required
INDEPENDENT THIRD-PARTY FOUNDATION REFERRALS
- Some patients may be able to receive other financial assistance from other independent third parties
- Relypsa does not determine the eligibility requirements of programs administered by independent third-party foundations
- Financial disclosures may be required
- Patients can call VELTASSA K+onnect to be warm transferred to an independent third-party foundation if appropriate
- Referral to an independent third-party foundation is not a guarantee of co-pay assistance
- Call VELTASSA K+onnect to learn more about the eligibility requirements for foundation support
VELTASSA K<sup class="plus">+</sup>onnect can offer support to patients when they need it
NURSE ADVOCATE SUPPORT
- Patients will receive a welcome call from a Nurse Advocate
- Nurse Advocates arrange for delivery of VELTASSA through the VELTASSA Start Program (if applicable)
- Patients are provided a toll-free hotline to a Nurse Advocate to answer their general questions about the product and disease-state information, as well as provide ongoing informational support
CASE MANAGER SUPPORT
- Case Managers specialize in helping patients understand their health plan coverage, including potential financial assistance options
- A toll-free support hotline provides easy access to a Case Manager
- Case Managers can also assist HCP offices with benefits investigations and information regarding the PA and appeals process
- Stay-on-Track Program communications include:
Recipes to support a
Reminders about taking
All patients taking VELTASSA can call VELTASSA K+onnect directly to self-enroll in the Stay-on-Track Program
VELTASSA K+onnect does not provide medical advice. Patients should consult their HCP if they have any questions about their health or treatment.
VELTASSA is available through specialty and retail pharmacies
In-network specialty pharmacy
(through VELTASSA K+onnect)
- Starter Rx form
- Physician portal
- Direct delivery to patient
Non-network specialty pharmacy
- Paper prescriptions
- Direct delivery to patient
- Paper prescriptions
- Patient picks up at local pharmacy
Non-network and retail pharmacy patients who need additional assistance can contact your office or call VELTASSA K+onnect directly to enroll*
Patients who fill their prescriptions at a non-network specialty pharmacy or retail pharmacy are not eligible for the VELTASSA Start Program.
Discover the VELTASSA K+onnect Physician Portal
VELTASSA is FDA approved and available for prescription
Please contact your VELTASSA representative or VELTASSA K+onnect at
VELTASSA Start Program Terms & Conditions
- Box checked on the Starter Form
- Form is completed with valid prescription, including physician signature
- Patient has a valid address in the United States (includes anyone who lives in one of the US states, the District of Columbia, Puerto Rico, and US Virgin Islands)
- Confirm patient has diagnosis of hyperkalemia
- Confirm patient is new start to VELTASSA
- Conduct nurse welcome call to patient to schedule overnight delivery
- Initial 15-day supply must be the 8.4 g packets
- If benefit verification/coverage is still pending at 5 days post first shipment, call patient to schedule and provide a second 15-day supply of VELTASSA
Program Terms & Conditions
By participating in the $25 Co-pay Program (“Co-pay Program”) for VELTASSA, the patient acknowledges that at the time of usage, they currently are enrolled in VELTASSA K+onnect, meet the eligibility criteria, and comply with the following terms and conditions.
The Co-pay Program is for commercially insured patients. Patients with prescription coverage through any type of federal or state government funded program are not eligible (e.g., Medicare, Medicaid, TRICARE, Veterans Administration (VA), Mi Salud).
The patient is responsible for $25 or the full amount of their copay per prescription fill, whichever is less, up to a 12 month period and afterwards renewal is required. The Co-pay Program for VELTASSA is not insurance. Relypsa, Inc. reserves the right to rescind, revoke, or amend this program without notice. The patient must use the Co-pay Program for a valid prescription of VELTASSA, and this cannot be combined with any other coupon, trial, savings card, free drug assistance, or other offer.
Patient must live in the United States (including the District of Columbia, Puerto Rico and the US Virgin Islands). Patient is required to promptly inform VELTASSA K+onnect of any change in insurance status during the course of enrollment.
The patient and participating pharmacy are each obligated to inform the insurance plan of any benefit received under the Co-pay Program as required, and may not participate if the Co-pay Program conflicts with the plan’s policy. No party may seek reimbursement for any part of the benefit received by patient under the Co-pay Program. Limit one per person, offer is non-transferable, and void where prohibited by law, taxed, or restricted.
Please call VELTASSA K+onnect for more information.
Important Safety Information
Contraindications: VELTASSA is contraindicated in patients with a history of a hypersensitivity reaction to VELTASSA or any of its components.
Worsening of Gastrointestinal Motility: Avoid use of VELTASSA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders, because VELTASSA may be ineffective and may worsen gastrointestinal conditions. Patients with a history of bowel obstruction or major gastrointestinal surgery, severe gastrointestinal disorders, or swallowing disorders were not included in clinical studies.
Hypomagnesemia: VELTASSA binds to magnesium in the colon, which can lead to hypomagnesemia. In clinical studies,hypomagnesemia was reported as an adverse reaction in 5.3% of patients treated with VELTASSA. Approximately 9% of patients in clinical trials developed hypomagnesemia with a serum magnesium value <1.4 mg/dL. Monitor serum magnesium. Consider magnesium supplementation in patients who develop low serum magnesium levels.
Adverse Reactions: The most common adverse reactions (incidence ≥2%) are constipation, hypomagnesemia, diarrhea, nausea, of the lips.abdominal discomfort and flatulence. Mild to moderate hypersensitivity reactions were reported in 0.3% of patients treated with VELTASSA and included edema