Resources for
ABBVIE CONTIGO IS AN EXCEPTIONAL EXPERIENCE DESIGNED WITH PATIENTS IN MIND
†Terms and Conditions apply.
Help patients get the support they need to start and stay on track with their prescribed treatment plan.
all necessary sections of the Enrollment & Referral Form
the form to AbbVie Contigo
1-888-979-8019
your patients they have been referred to AbbVie Contigo and they will receive a call from their Care Specialist*
Use these forms to help patients with access and coverage for HUMIRA.
Appeals Letter Sample Template
Download
Letter Of Medical Necessity
Sample Template
Formulary Exception Letter
Sample Template (Rheumatology)
Formulary Exception Letter
Sample Template (Dermatology)
Formulary Exception Letter
Sample Template (Gastroenterology)
Specialty Pharmacy Resources
Download*Care Specialists are provided by AbbVie and do not provide medical advice or work under the direction of the prescribing health care professional (HCP). They are trained to direct patients to speak with their HCP about any treatment-related questions, including further referrals.
†Terms and Conditions apply. This benefit covers HUMIRA® (adalimumab). Eligibility: Available to patients with commercial prescription insurance coverage for HUMIRA who meet eligibility criteria. Co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Ahorros Contigo Savings Card for HUMIRA and patient must call AbbVie Contigo at 1.855.CONTIGO to stop participation. Patients moving o residing outside Puerto Rico may not be eligible. Patients may not seek reimbursement for value received from the AbbVie Contigo program from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This assistance offer is not health insurance. To learn about AbbVie’s privacy practices and your privacy choices, visit www.abbvie.com/privacy.html.
Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids.
Discontinue HUMIRA if a patient develops a serious infection or sepsis.
Reported infections include:
Carefully consider the risks and benefits of treatment with HUMIRA prior to initiating therapy in patients: 1. with chronic or recurrent infection, 2. who have been exposed to TB, 3. with a history of opportunistic infection, 4. who resided in or traveled in regions where mycoses are endemic, 5. with underlying conditions that may predispose them to infection. Monitor patients closely for the development of signs and symptoms of infection during and after treatment with HUMIRA, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.
Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including HUMIRA. Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers, including HUMIRA. These cases have had a very aggressive disease course and have been fatal. The majority of reported TNF blocker cases have occurred in patients with Crohn’s disease or ulcerative colitis and the majority were in adolescent and young adult males. Almost all of these patients had received treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants.
Please see Full Prescribing Information.
Reference: 1. HUMIRA Injection [package insert]. North Chicago, IL: AbbVie Inc.