Libtayo Prescription Assistance Programs

Libtayo: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Libtayo. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not or go to the program website.

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Libtayo Surround Program

(Program 1 of 1 — Scroll down to see them all )

Provided by: Sanofi and Regeneron Pharmaceuticals, Inc.
PO Box 220262 Charlotte, NC 28211-0262
TEL: 877-542-8296
FAX: 833-853-8362
Languages Spoken:
English, Others By Translation Service
Program Website
Program Applications and Forms
  • Libtayo (cemiplimab-rwlc)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? No
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? Must be residing in the US or US territory
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 24-48 hours
  • Amount/Supply Varies
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Contact Program for Details
  • Refill Proces Refill form sent with each supply
  • Limit One calendar year
  • Re-application New application, new documentation yearly
Additional Information
This program also provides co-pay and reimbursement assistance.
Updated August 7, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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