With commercial insurance: Alexion OneSource CoPay Program — as little as $0, a yearly max that is not published on current terms (last published $15,000 a year). With Medicare: the Ultomiris card can’t be used. 6 foundation funds are open today (as of September 28, 2026). See them by diagnosis below.
See what this patient owes after assistance →
8 assistance programs for Ultomiris patients · 7 open today
One Alexion (AstraZeneca Rare Disease) program applies to Ultomiris: the Alexion OneSource CoPay Program Program, a commercial copay card at as little as $0 per prescription with a yearly cap that is not published on current terms (last published $15,000 a year). Alexion does not run a free-drug program for Ultomiris. At the 3,300 mg maintenance dose and 20% coinsurance priced at the Medicare reference rate, the drug line alone on one infusion is $14,945.96, nearly the whole $15,000 annual card.
Select the patient's insurance and diagnosis to see which programs apply.
Current status · Award amounts · Eligibility · Direct application links September 28, 2026
Checked September 28, 2026 · Source 1 ↗ · Source 2 ↗
Ultomiris’s card can’t be used with Medicare. These funds may help. They open and close with donations, so call before telling a Ultomiris patient no.
Checked September 28, 2026 · Source 1 ↗ · Source 2 ↗
Ultomiris · PNH · Commercial insurance
Eligible patients may pay $0
Example · Ultomiris · 3300 mg · 330 units · commercial plan · deductible met · 20% coinsurance · allowed amounts at the Medicare reference rate
| Without assistance | With Alexion OneSource CoPay Program | |
|---|---|---|
| Drug responsibility | $14,945.96 | $0.00 |
| Administration (96365) | $13.43 | $0.00 |
| Patient owes | $14,959.39 | $0.00 |
Estimated patient savings: $14,959.39
CareCost calculates the drug and administration lines using the patient’s payer rate and benefits; this example uses the Medicare rate as a reference.
Maximum award $9,500
PAN Foundation fund for government-insured patients with Paroxysmal Nocturnal Hemoglobinuria (confirmed diagnosis).
Maximum award See program
The Assistance Fund fund for government-insured patients with Diagnosis of aHUS with prescription for FDA-approved treatment.
Maximum award See program
The Assistance Fund fund for government-insured patients with Diagnosed with Myasthenia Gravis; prescription for FDA-approved treatment.
Maximum award See program
The Assistance Fund fund for government-insured patients with Diagnosed with NMOSD; prescription for FDA-approved treatment.
Maximum award See program
The Assistance Fund fund for government-insured patients with FDA-approved treatment prescription required and covered by health insurance.
Checked, and not available for this drug today
Free Alexion OneSource Patient Assistance Program for eligible patients
Change the diagnosis to see only the programs that apply to your patient.
| Task | ✓ |
|---|---|
| Find programs for the diagnosis | ✓ |
| See whether each program is open | ✓ |
| See maximum award | ✓ |
| Review key eligibility requirements | ✓ |
| Open the official application | ✓ |
| Calculate cost before assistance | ✓ |
| Apply the program benefit | ✓ |
| Calculate what the patient still owes | ✓ |
Commercial insurance: The Alexion OneSource CoPay Program Program is Alexion (AstraZeneca Rare Disease)'s commercial copay card. Eligible patients may pay as little as $0 per prescription, with a yearly cap that is not published on current terms (last published $15,000 a year). An Ultomiris claim carries two lines, the drug (J1303, billed by weight band) and the 96365 infusion administration; the card's benefit line is for the drug charge. At the 60 to under 100 kg maintenance dose (3,300 mg, 330 units), the reference rate allows $74,796.96 and a 20% coinsurance on the drug line alone is $14,945.96, close to the full $15,000 annual maximum from a single infusion. Federally funded commercial plans are not eligible. View current program ↑
Uninsured or underinsured: Alexion does not run a free-drug program for Ultomiris (checked September 28, 2026). If a patient does not qualify for the co-pay program, Alexion OneSource (888-765-4747) can connect them to third-party resources.
Medicare: What is available instead is the foundation funds together with Medigap. The PAN Foundation's Paroxysmal Nocturnal Hemoglobinuria and Myasthenia Gravis funds and each of The Assistance Fund's four disease funds accept Medicare patients. Medigap caps the Part B coinsurance on top of any fund: at the 3,300 mg maintenance dose, Plan K reduces the $14,959.39 coinsurance to $7,479.69 with the deductible met or $7,734.39 if not, and Plan L to $3,739.85 or $4,008.70. See Medigap out-of-pocket by plan →
Diagnosis-specific funds: The two Alexion programs are not diagnosis-gated: eligibility runs on insurance status alone, so both apply the same way across all four indications — PNH (D59.5), aHUS (D59.39), generalized myasthenia gravis (G70.00) and NMOSD (G36.0). Seven foundation funds are diagnosis-specific for Ultomiris; two more PAN funds on the list do not match Ultomiris's J1303 and are not counted here. To see which are open now, check each fund's current status on the funds list. See the funds question below for which is which.
Yes. The Alexion OneSource CoPay Program Program is Alexion (AstraZeneca Rare Disease)'s commercial copay card: eligible patients may pay as little as $0 per prescription, with a yearly cap that is not published on current terms (last published $15,000 a year). It applies to commercial insurance only and excludes Medicare, Medicaid, TRICARE, VA and other government insurance. Apply at alexiononesource.com ↗ Calculate cost with the program →
The card's benefit line is for the Ultomiris drug charge (J1303, billed by weight band) only with a yearly cap that is not published on current terms (last published $15,000 a year). The 96365 infusion administration charge is billed on a separate line. View current program ↑
No. The Alexion OneSource CoPay Program Program for Ultomiris is commercial only, and Alexion runs no free-drug program for Ultomiris. A Medicare patient's route to assistance runs through the foundation funds instead: the PAN Foundation's Paroxysmal Nocturnal Hemoglobinuria and Myasthenia Gravis funds and each of The Assistance Fund's four disease funds accept Medicare. See Medigap out-of-pocket by plan →
No. Alexion does not run a free-drug program for Ultomiris (checked September 28, 2026). Alexion OneSource (888-765-4747) can connect a patient who does not qualify for the co-pay program to third-party resources. Contact Alexion OneSource ↗
Seven match Ultomiris's J1303: the PAN Foundation's Paroxysmal Nocturnal Hemoglobinuria fund (up to $9,500 a year) and Myasthenia Gravis fund (up to $10,000 a year plus a separate premium-assistance fund); The Assistance Fund's Paroxysmal Nocturnal Hemoglobinuria, Atypical Hemolytic Uremic Syndrome and Myasthenia Gravis funds (amounts not published, see program); The Assistance Fund's Neuromyelitis Optica Spectrum Disorder fund (fixed copay grant); and Good Days' Neuromyelitis Optica fund (contact Good Days for the amount). Check each fund's current status on the funds list. Two more PAN funds on the list, for Hemolytic Uremic Syndrome and NMOSD, don't list J1303 among the drugs they match and are not counted here. Check today's status ↑
26 of 29 payers in our corpus require prior authorization for ravulizumab, and 25 of 29 require another product first for at least one indication — pyridostigmine and an immunosuppressant or a preferred FcRn product for myasthenia gravis, rituximab for NMOSD, while PNH and aHUS reviews mostly confirm the diagnosis rather than a prior step. The Alexion co-pay program does not resolve a denial; that goes through the payer's appeal or reconsideration process first. Check this patient's payer →
Ultomiris shares its class with Piasky (J1307, Genentech), billed under its own code with its own manufacturer programs. The programs above apply to Ultomiris only. If the payer requires the other product instead, use that manufacturer’s program below.
Each card is the program record on file, verified on the date it shows. None of them pays the administration line.
Genentech Access Solutions Co-Pay
Genentech Patient Foundation
Data current: programs verified Sep 28, 2026
Alexion (AstraZeneca Rare Disease) (Alexion OneSource CoPay Program Program), the PAN Foundation, The Assistance Fund and Good Days. Every program links directly to its official source or application page.
Last program check: .
Reviewed September 21, 2026 by Erin Rose, CareCost Estimate founder. Methodology →
CareCost