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About Financial Assistance & Insurance Navigation Ordering Information Resources

Financial Assistance & Insurance Navigation

Financial support options may be available to your eligible patients through SpringWorks CareConnections. We also provide resources and assistance to support timely access to GOMEKLI^® (mirdametinib).

Your eligible commercially insured patients can visit gomeklicopay.com, click on the “Enroll in Copay Program” button under the “Insurance Navigation & Financial Help” tab to review information about the program, and begin online enrollment.

Patient Assistance Program (PAP)

Eligible patients who are uninsured, underinsured, or lack coverage for GOMEKLI may be able to receive medication at no cost.^†

Note: Self-enrollment in the Commercial Copay Program is only available for copay assistance for GOMEKLI. To qualify for reimbursement for eligible treatment-related costs, a patient must be enrolled in the full SpringWorks CareConnections program.

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Terms and conditions apply. Copay program for GOMEKLI and reimbursement for eligible treatment-related costs are subject to annual benefit maximums. To receive the reimbursement of eligible treatment-related expenses, an Explanation of Benefits (EOB) form must be submitted, along with copies of receipts for any payments made by your patient. The servicing provider may also submit a copy of the invoice for services rendered to your patient. Full terms and conditions provided during enrollment process and are available upon request by contacting SpringWorks CareConnections at 844-CARES-55 (844-227-3755).

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Terms and conditions apply. PAP eligibility criteria and annual household income limits apply. Full terms and conditions provided during enrollment process and are available upon request by contacting SpringWorks CareConnections at 844-CARES-55 (844-227-3755).

To find out more about how your patients may save on the cost of GOMEKLI, call us at 844‑CARES‑55 (844‑227‑3755), Monday-Friday 8 AM-8 PM ET.

Insurance Navigation

Coverage Support

We’ll provide education on your patients’ insurance coverage and plan requirements.

Benefits investigation

Obtain benefits investigation results promptly to determine patients’ coverage and out-of-pocket costs for GOMEKLI^® (mirdametinib), as well as certain treatment-related costs that may be incurred during treatment with GOMEKLI.

If you have questions about your patients’ insurance coverage for GOMEKLI, call us today at 844-CARES-55 (844-227-3755), Monday-Friday 8 AM-8 PM ET or Connect With a FAM.

Prior Authorization (PA) and Appeals Support

Have questions about PA processes or denials? Our Patient Support Specialists can help.

Our Patient Support Specialists can:

Help navigate the PA process promptly and accurately
Provide information on the appeals process if coverage or a PA is denied

For sample letters and additional resources for you and your office staff to help your patients get started and stay on track with GOMEKLI, visit our Resources & Forms page.

Field Access Managers (FAMs)

FAMs are available to help answer questions about process and payor requirements.

Temporary free medication programs for your eligible patients experiencing coverage delays or interruptions:

QUICK START PROGRAM

Eligible commercially insured patients who experience a qualified delay in their insurance coverage may be able to get started on GOMEKLI at no cost for a limited period of time.^‡

BRIDGE PROGRAM

Eligible patients with commercial or government insurance currently on GOMEKLI who experience a qualified gap in their insurance coverage may qualify to receive GOMEKLI at no cost for a limited period of time.^‡

^‡	Terms and conditions apply. Full terms and conditions provided during enrollment process and are available upon request by contacting SpringWorks CareConnections at 844-CARES-55 (844-227-3755).

To learn more about how SpringWorks CareConnections can support you and your patients, please see the SpringWorks CareConnections HCP Brochure

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Independent Patient Assistance Foundations

Financial assistance may be available through independent foundations that are not controlled by or otherwise affiliated with SpringWorks CareConnections. These foundations may be able to assist with, for example, copays, premiums, patient education, and social services.

Explore additional foundations that may be able to provide your patients with financial assistance

This link is created and customized for SpringWorks Therapeutics ("SpringWorks") by Real Endpoints, LLC ("RealEndpoints"). RealEndpoints is an independent third-party service provider. SpringWorks does not control the operation of RealEndpoints, the foundations included in this link, or any foundation's eligibility criteria, funding decisions, or operations. SpringWorks is providing a link to these foundations to help patients find more information about potential assistance, but inclusion on this list does not represent an endorsement or a recommendation from SpringWorks for any group or organization. SpringWorks cannot guarantee assistance will be provided. Details and eligibility requirements can be found directly on the individual foundation websites.

Find foundations

Have Questions?

Call SpringWorks
CareConnections today

844-CARES-55

(844-227-3755)

Monday-Friday
8 AM-8 PM ET

Field Access
Manager (FAM) Support

For questions about patient access to
GOMEKLI, click to connect with a FAM

OGSIVEO, GOMEKLI, PIMJETMI, and SpringWorks CareConnections are registered trademarks of Merck KGaA, Darmstadt, Germany and/or its affiliates. All other trademarks are the property of their respective owners.

EMD Serono, Inc. and SpringWorks Therapeutics, Inc. are healthcare companies of Merck KGaA, Darmstadt, Germany.

US-GOM-01397 11/26

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