Complete a DUPIXENT MyWay enrollment form
Select the indication-specific enrollment form
for your patient
View enrollment form (PDF format): English 
Please see full indications below.
How to submit
Send the full enrollment form (pages 1-5) and insurance information via:
- Fax: 1-844-387-9370
- Electronic upload: DUPIXENTMyWayPortal.com (use code: 8443879370)
Looking for more tips to help you complete an Enrollment Form?
What happens next?
With the enrollment form, you can choose how DUPIXENT MyWay supports you and your patient with benefits investigation and prescription triage.
If consent has not already been provided, DUPIXENT MyWay will contact your patient with a request to provide their consent to enroll in the program. Once consent is received, we will welcome them and share more details about the available support services.
Contact your Field Reimbursement Manager or call 1-844-DUPIXENT
(1-844-387-4936) Option 1, Monday-Friday, 8 am-9 pm ET to speak with a
DUPIXENT MyWay Case Manager.
Financial assistance
DUPIXENT MyWay can connect eligible patients to copay support or other financial assistance programs