SpringWorks CareConnections^® Commercial Copay Program

If you have commercial health insurance, you may pay as little as a $0 copay per 21-day supply of GOMEKLI^® (mirdametinib) with the Commercial Copay Program.* There are no income requirements to participate in the program. Please review the information below and the program terms and conditions, and then click “Begin Copay Enrollment,” to find out if you are eligible.

Begin Copay Enrollment

*	Terms, conditions, and eligibility criteria apply. Copay program is subject to an annual benefit maximum. Full terms and conditions are provided upon enrollment in the program and are available here.

By clicking “Begin Copay Enrollment,” you will be redirected to the copay portal where you can complete the online form to enroll in the program and sign the required authorizations. The information you provide in this form will be used to determine your eligibility for the Commercial Copay Program and any other SpringWorks CareConnections programs you may choose to participate in, as well as for the purpose of administering these programs.

What to expect after submitting your online form

If eligible, a copay card with your unique identification numbers will automatically be generated.^†

Phone

Call your Specialty Pharmacy (SP) or the in-office pharmacy at your doctor’s office and provide them with your card information.

Expect a welcome call from a SpringWorks CareConnections Nurse Advocate within 24 hours of your approval.

For questions about the Commercial Copay Program or for help enrolling, give SpringWorks CareConnections a call at 844-CARES-55 (844-227-3755), Monday-Friday 8 AM-10 PM ET.

Begin Copay Enrollment

^†	Program eligibility will be reverified prior to use of the card.

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OGSIVEO, GOMEKLI, and SpringWorks CareConnections are registered trademarks of SpringWorks Therapeutics, Inc. All other trademarks are the property of their respective owners.

SpringWorks Therapeutics, Inc. is a healthcare company of Merck KGaA, Darmstadt, Germany.

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