ENROLLMENT FORM

CONNECT WITH KYOWA KIRIN CARES

Call 833-KK-CARES (833-552-2737) Monday through Friday, 8 AM to 8 PM (ET),
to speak with a Kyowa Kirin Cares Case Manager

Actor Portrayals.

GET HELP WITH ACCESS OPTIONS

Kyowa Kirin Cares can provide assistance navigating access options for CRYSVITA®(burosumab-twza).

Commercial insurance

Commercial Insurance

If you have commercial insurance, you may be eligible to receive co-pay assistance for CRYSVITA through the Kyowa Kirin Cares Co-Pay Assistance Program. Please review the full terms and conditions* for more information.

Government insurance

Government Insurance

If you have government or military insurance, including Medicare, Medicaid, or TRICARE, a dedicated case manager will be able to walk you through available financial options.a

No insurance

No Insurance

If you do not have insurance, you may be eligible to receive CRYSVITA for free through the Patient Assistance Program. Review the terms and conditions to learn if you qualify.b

For people with government insurance

Through independent organizations outside of Kyowa Kirin, you may be able to receive additional support, such as:

  • Help with monthly premiums
  • Assistance with annual deductibles
  • Reduced costs for brand-name drugs
  • Assistance with Medicare costs

To learn more:
Call 1-800-MEDICARE(1-800-633-4227; TTY users call 1-877-486-2048) or visit medicare.gov

  1. a Select government- and military-insured patients who are experiencing financial and/or medical hardship may be eligible to receive assistance through a Patient Assistance Program. Kyowa Kirin recognizes that exceptions need to be made based on a patient's individual circumstances. If patients do not meet the coverage criteria and there are special circumstances of financial and/or medical hardship that apply to their situation, they can request that an exception be made for them.
  2. b Patients must be US residents with no active medical or pharmacy benefit insurance or no coverage for CRYSVITA under their medical or pharmacy benefit insurance and an annual gross income at or below 400% of the federal poverty level, confirmed by documented proof of income. Call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737) for additional information.

*Kyowa Kirin Cares Co-Pay Assistance Program Terms and Conditions

The Kyowa Kirin Cares Co-Pay Assistance Program for CRYSVITA helps commercially insured individuals who are residents of the United States (including the United States territories) and who are prescribed CRYSVITA for a use approved by the Food and Drug Administration (FDA) pay for their eligible out-of-pocket costs and cost-sharing for CRYSVITA and the associated cost-sharing for drug administration, up to a specified maximum benefit per calendar year. To learn the maximum benefit of financial assistance available to you under the Kyowa Kirin Cares Co-Pay Assistance Program, call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737). Depending on your commercial insurance plan and/or provider setting assistance under the Kyowa Kirin Cares Co-Pay Assistance Program may be provided via a pre-loaded debit card that can be utilized to pay your cost-sharing obligation for CRYSVITA and its administration or through a co-pay card that adjudicates as secondary insurance or a combination of both.

Note that individuals residing in Massachusetts or Rhode Island (or elsewhere as prohibited by law) may not be eligible for financial assistance related to the administration/injection of CRYSVITA. In order to be eligible for the Program, individuals must provide a signed authorization compliant with the Health Insurance Portability and Accountability Act of 1996 and the regulations thereunder (collectively “HIPAA”). The Program does not cover the costs of physician office visits or evaluations, blood work or other testing, or transportation or other related services. The Program is NOT insurance.

Void if copied, transferred, purchased, altered, or traded, and where prohibited and restricted by law. For additional terms and conditions, call Kyowa Kirin Cares at 833-KK-CARES (833-552-2737).

Call 833-KK-CARES (833-552-2737)
Monday through Friday, 8 AM to 8 PM (ET)

RECEIVE PERSONALIZED AND ONGOING SUPPORT

Kyowa Kirin Cares is committed to supporting you throughout your journey with CRYSVITA.

Your dedicated Case Manager can support you by:

Answering general questions about CRYSVITA

Helping you stay on track with your treatments

Providing education tools and resources

Calling routinely to check in and offer support

Work closely with your Kyowa Kirin Cares Case Manager and healthcare provider to ensure you are receiving the support you need throughout your journey with CRYSVITA.

FIND IMPORTANT FORMS AND RESOURCES

Access Kyowa Kirin Cares forms as well as useful CRYSVITA information and resources.

Support brochure

Download this Kyowa Kirin Cares brochure and use it as a quick reference for program offerings.

download

Doctor discussion guide

Use this resource to guide conversations about CRYSVITA with your healthcare provider

download

About CRYSVITA

Visit the CRYSVITA website to learn more about how CRYSVITA works, and details around the CRYSVITA injection schedule.

Visit Site

What is CRYSVITA?

CRYSVITA is a prescription medicine used to treat:

  • Adults and children 6 months of age and older with X-linked hypophosphatemia (XLH)
  • Adults and children 2 years of age and older with fibroblast growth factor 23 (FGF23)–related hypophosphatemia in tumor-induced osteomalacia (TIO) when the tumor cannot be located or removed

Important Safety Information

You should not take CRYSVITA if:

  • You take an oral phosphate supplement and/or a specific form of vitamin D supplement (such as calcitriol, paricalcitol, doxercalciferol, calcifediol).
  • Your phosphorus levels from a blood sample are within or above the normal range for age.
  • You have kidney problems.

What is the most important information you should know about CRYSVITA?

  • Some patients developed allergic reactions (e.g., rash and hives) while taking CRYSVITA. Your doctor will monitor you for symptoms of an allergic reaction while you are taking CRYSVITA.
  • High levels of phosphorus in the blood have been reported in some patients taking CRYSVITA. This may be related to a risk of high calcium levels in the kidneys. Your doctor will collect blood samples to monitor your levels.
  • Administration of CRYSVITA may result in reactions at the injection site, such as hives, reddening of the skin, rash, swelling, bruising, pain, severe itching of the skin, and collection of blood outside of a blood vessel (i.e., hematoma).
  • If you are taking CRYSVITA for TIO, your doctor will have you stop your CRYSVITA treatment temporarily if you are undergoing treatment for your tumor (e.g., surgical removal of the tumor or radiation therapy).

What are the possible side effects of CRYSVITA?

  • Adverse reactions that were seen in children with XLH are:
    • Fever
    • Injection site reaction
    • Cough
    • Vomiting
    • Pain in arms and legs
    • Headache
    • Tooth abscess
    • Dental cavities
    • Diarrhea
    • Decreased vitamin D levels
    • Toothache
    • Constipation
    • Muscle pain
    • Rash
    • Dizziness
    • Nausea
  • Adverse reactions that were seen in adults with XLH are:
    • Back pain
    • Headache
    • Tooth infection
    • Restless legs syndrome
    • Decreased vitamin D levels
    • Dizziness
    • Constipation
    • Muscle spasms
    • Phosphorus levels increased in the blood
  • Narrowing of the spaces within the spine is common in adults with XLH, and pressure on the spinal cord has been reported in adults taking CRYSVITA. It is not known if taking CRYSVITA worsens the narrowing of the spaces within the spine or the pressure on the spinal cord.
  • Adverse reactions that were seen in adults with TIO are:
    • Tooth abscess
    • Muscle spasms
    • Dizziness
    • Constipation
    • Injection site reaction
    • Rash
    • Headache

Before taking CRYSVITA, tell your doctor about all of your medications (including supplements) and medical conditions, including if you:

  • Are taking oral phosphate and/or active vitamin D (such as calcitriol, paricalcitol, doxercalciferol, calcifediol).
  • Are pregnant, think you may be pregnant, or plan to become pregnant. There is not enough experience to know if CRYSVITA may harm your unborn baby. Report pregnancies to the Kyowa Kirin, Inc. Adverse Event reporting line at 1-844-768-3544.
  • Are breastfeeding or plan to breastfeed. There is not enough experience to know if CRYSVITA passes into your breast milk. Talk with your doctor about the best way to feed your baby while you receive CRYSVITA.

While taking CRYSVITA, tell your doctor if you experience:

  • An allergic reaction such as rash or hives
  • A rash, swelling, bruising, or other reaction at the injection site
  • New or worsening restless legs syndrome

These are not all the possible side effects of CRYSVITA. Call your doctor for medical advice about side effects.

You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Kyowa Kirin, Inc. at 1-844-768-3544.

For important risk and use information, please see the full Prescribing Information