Steps for Reimbursement

1. Complete and Fax SMN

Complete the Statement of Medical Necessity (SMN) form and have your patient sign it. Then, fax the form and a copy of your patient's insurance card to PACE^SM at 1-866-435-4471. Once PACE receives the completed form, your patient will begin to work with one of the program's Patient Care Liaisons (PCLs).

If you wish to speak with a PACE PCL, please call 1-866-435-5677. Download the SMN »

2. A PCL from PACE Will Contact Your Patient

Within 24 hours of receiving a completed Statement of Medical Necessity (SMN) referral form, a PCL will be assigned to the patient case. The PCL can determine and communicate the patient's insurance benefits, payer requirements and out-of-pocket costs for Increlex, coordinate delivery of Increlex therapy at no cost for eligible patients* and arrange for injection training and ongoing educational support through the Ipsen Nurse Network at your request.

3. Patient Services

In addition to determining insurance benefits and requirements, coordinating delivery of Increlex starter therapy and arranging training and education through the Ipsen Nurse Network, the PCL can also:

• Explain Increlex  financial assistance programs to help reduce out-of-pocket costs
  • PACE offers a patient assistance program for uninsured patients who meet the program criteria
  • Ipsen is proud to support Patient Services, Inc. (PSI).  PSI is an independent 501(c)(3) non-profit, charitable organization that offers co-pay assistance for eligible patients living with severe Primary IGFD
• Coordinate services and provide materials:
  • Coordinate delivery of Increlex through our specialty pharmacy network
• Provide educational materials on Increlex and severe Primary IGFD for the patient and their family

4. Continuity of Care

PACE works directly with the specialty pharmacy and insurance company to get your patient started on Increlex and to help encourage your patient to follow their prescribed dosing schedule.

5. Shipment Follow-Up

In addition to providing access to injection training, PACE PCLs will follow-up with your patients by telephone, to ensure that their Increlex shipment has been delivered on time to the correct location.

Download the PACE brochure (.pdf) to learn more.

For more information, please call PACE 1-866-435-5677.

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*Eligible patients may receive up to 8 months of Increlex therapy at no cost if the following criteria are met: Patient has been diagnosed with severe Primary IGFD. Patient's prescriptions are not paid in part or full by any state-funded or federally-funded programs, including but not limited to Medicare, Medicaid, Medigap, VA, DOD or TriCare. Patient is not a resident of Massachusetts. Insurance coverage for Increlex is actively being pursued by the prescriber. The patient's insurance company has not yet communicated a final coverage decision. Ipsen reserves the right to deny free starter drug therapy to anyone deemed ineligible with the with the stated program criteria.

Indication and Important Safety Information

INCRELEX^® (mecasermin [rDNA origin] injection) is indicated for the treatment of growth failure in children with severe primary IGF-1 deficiency, or with growth hormone (GH) gene deletion who have developed neutralizing antibodies to GH. Severe primary IGF-1 deficiency (IGFD) is defined by height standard deviation score ≤ -3.0 and basal IGF-1 standard deviation score ≤ -3.0 and normal or elevated growth hormone (GH). Severe Primary IGFD includes classical and other forms of growth hormone insensitivity. Patients with Primary IGFD may have mutations in the GH receptor (GHR), post-GHR signaling pathway including the IGF-1 gene. They are not GH deficient, and therefore, they cannot be expected to respond adequately to exogenous GH treatment.

INCRELEX is not intended for use in subjects with secondary forms of IGF-1 deficiency, such as GH deficiency, malnutrition, hypothyroidism, or chronic treatment with pharmacologic doses of anti-inflammatory steroids. Thyroid and nutritional deficiencies should be corrected before initiating INCRELEX treatment.

Limitations of use: INCRELEX is not a substitute to GH for approved GH indications.

INCRELEX is contraindicated in the presence of active or suspected malignancy, and therapy should be discontinued if evidence of malignancy develops. INCRELEX should not be used by patients who are allergic to mecasermin (rhIGF-1) or any of the inactive ingredients in INCRELEX, or who have experienced a severe hypersensitivity to INCRELEX [see Warnings and Precautions and Adverse Reactions]. Intravenous administration of INCRELEX is contraindicated. INCRELEX should not be used for growth promotion in patients with closed epiphyses.

INCRELEX has insulin-like hypoglycemic effects and should be administered 20 minutes before or after a meal or snack. Hypersensitivity and allergic reactions have been reported, including a low number of cases indicative of anaphylaxis requiring hospitalization. Intracranial hypertension has occurred in patients treated with INCRELEX. Funduscopic examination is recommended at the initiation of and periodically during the course of therapy. Patients should have periodic examinations to rule out potential complications from tonsillar/adenoidal hypertrophy and receive appropriate treatment if necessary. Children with onset of limp or hip/knee pain should be evaluated for possible slipped capital femoral epiphysis. Monitor any child with scoliosis for progression of the spine curve.

In clinical studies of 71 pediatric subjects with severe Primary IGFD representing 274 patient-years of treatment, no subjects discontinued due to adverse events. Hypoglycemia was reported by 30 subjects (42%) at least once during their course of therapy with INCRELEX. Most cases of hypoglycemia were mild or moderate in severity. Five subjects had severe hypoglycemia (requiring assistance and treatment) on one or more occasion and four subjects experienced hypoglycemic seizures/loss of consciousness on one or more occasion. Symptomatic hypoglycemia was generally avoided when a meal or snack was consumed either shortly (i.e., 20 minutes) before or after the administration of INCRELEX. Tonsillar hypertrophy was noted in 11 (15%) subjects in the first 1 to 2 years of therapy with lesser tonsillar growth in subsequent years. Intracranial hypertension occurred in three subjects. In two subjects the events resolved without interruption of INCRELEX treatment. INCRELEX treatment was discontinued in the third subject and resumed later at a lower dose without recurrence.

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