RenValue Card Authorization

To assist us with validating your eligibility for this offer, please answer the following questions designed to help determine if you are a Federal Healthcare Program beneficiary (whether you receive Medicare, Medicaid, etc.).

Are you a current resident of the United States or Puerto Rico?

Do you receive Medicaid?

Do you qualify for Medicare?

Answer Yes to this question if any of the following apply:
(a) you have end stage renal disease; or
(b) you are receiving social security payments because of a disability; or
(c) you are 65 years of age or older and neither you nor your spouse are working.

Do you fill your prescriptions through Medicare Part D (a Medicare drug plan)

Are you currently serving in the military?

Are you uninsured?

* Required fields

First Name*
Last Name*
Address 1* Address 2
City* State* Zip*

Please provide either an email address or phone number.

Email Address Cell Phone (XXX-XXX-XXXX)
Home Phone (XXX-XXX-XXXX)
What is your preferred mode of communication?*

You understand that the information you provide, as well as the information pertaining to the use of the card at the pharmacy, will be shared with Sanofi US, the sponsor of the card. The information disclosed will include the date that you filled the prescription, the product dispensed by your pharmacist, and the amount that Sanofi US will cover under the RenValue(SM) Savings Card program. This information will be available to Sanofi US, its affiliates, and the business service companies working with Sanofi US and may be used to send you additional information pertaining to this program. You also hereby agree to be contacted by mail, email, phone calls, voice messages, SMS text messages* and interactive voice recordings. Sanofi will only text you with your permission; carrier fees may apply.

You understand that you do not have to enroll in the Program and that you can still receive Renvela® as prescribed by your physician.

Your authorization shall remain in effect throughout your participation in the Program, unless and until you withdraw or “take back” this authorization. You can withdraw your authorization or opt out of the Program at any time by calling Customer Service at 1-866-257-4605.

This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. Should you begin receiving prescription benefits from any federal, state, or government funded program at any time, you will no longer be eligible to participate in this program. If you do not qualify for RenValue, please call Sanofi at 1-800-633-1610 and select option 2 to find out about what other services and assistance programs may be available.

Indication

Renvela® is used to control phosphorus levels in adults and children 6 years of age and older with chronic kidney disease (CKD) on dialysis.

Important Safety Information

  • Do not use Renvela if you have a history of bowel obstruction or if you are allergic to sevelamer carbonate, sevelamer hydrochloride or to any of the ingredients in Renvela.
  • Talk to your doctor if you have had difficulty swallowing or swallowing disorders; or if you have had digestive tract surgery or other digestive disorders, including severe constipation.
  • The most frequently occurring side effects with Renvela tablets include nausea and vomiting.
  • Side effects with Renvela powder taken three times a day are similar to those reported for Renvela tablets.
  • The most common side effects with sevelamer include vomiting, nausea, diarrhea, indigestion, abdominal pain, flatulence, and constipation.
  • Cases of itching, rash, fecal impaction and, less commonly, slow bowel activity, bowel obstruction, and bowel perforation have been reported.
  • Uncommon cases of difficulty swallowing the Renvela tablet have been reported. Talk to your doctor if you have difficulty swallowing medicines in tablet form. Renvela for oral suspension may be considered by your doctor if you have a history of difficulty swallowing.
  • Your doctor should monitor your bicarbonate and chloride blood levels.
  • Reduced vitamins D, E, and K (clotting factors) and folic acid blood levels may be followed by your doctor.
  • Talk to your doctor when taking Renvela with other medications.
  • Promptly contact your doctor if you experience severe abdominal pain, new or worsening constipation, or other severe intestinal symptoms while on Renvela.
  • Take Renvela with meals and adhere to your prescribed diet.

Please see full Prescribing Information.

If you are a patient experiencing problems with a Sanofi US product while participating in the Renvalue Copay Program, please call Sanofi US at 1-800-633-1610