YCANTH Copay Assistance Program

Welcome to the YCANTH^®

Copay Assistance Program

Eligible, commercially-insured patients may pay as little as $25 for the first treatment, and $0 for subsequent treatments, if clinically needed (up to 4 treatments total)

To initiate this offer, complete the form below to confirm that the patient meets eligibility requirements and satisfies certain terms and conditions for the YCANTH Copay Assistance Program.*

*Terms, conditions, and limitations apply. Please see below for the Program's eligibility requirements and terms and conditions.

Please enter the name of the patient who will use this coupon.

Please enter the date of birth of the patient who will use this coupon.

Please enter the address of the patient who will use this coupon.

Please enter an email address for the patient/caregiver.

Please enter a mobile number for the patient/caregiver.

The patient has been diagnosed by their healthcare provider with Molluscum Contagiosum (diagnosis code: B08.1).

Agree
Disagree

The patient enrolling in the YCANTH Copay Assistance Program is a resident of the United States.

Agree
Disagree

The patient enrolling in the YCANTH Copay Assistance Program does not have coverage, in whole or in part, by Medicaid, Medicare, VA, Department of Defense ("DOD"), TRICARE (TRICARE^® is a registered trademark of DOD), DHA, or other federal or state programs including any state pharmaceutical assistance programs.

Agree
Disagree

The patient enrolling in the YCANTH Copay Assistance Program is at least two (2) years of age or older.

Agree
Disagree

I am the pharmacist or someone assisting the patient completing this form.

ELIGIBILITY CRITERIA/TERMS AND CONDITIONS:

Patients who are eligible to participate in the YCANTH Copay Assistance Program must agree to the following terms and conditions:

Patients must present a valid prescription for YCANTH to a participating pharmacy to receive a cost reduction on their out-of-pocket expense.
Program limits apply.
Patients must be diagnosed by their healthcare provider with Molluscum Contagiosum (diagnosis code: B08.1)
The YCANTH Copay Assistance Program is solely for patients' charges incurred in the use of YCANTH (cantharidin) topical solution and does not include any other related charges.
Patients using YCANTH must be at least two (2) years of age or older and must reside in the United States.
For all qualified patients, Verrica Pharmaceuticals is responsible for all YCANTH product costs under the Program amount and excluding the copay requirement. The Patient’s insurance provider can provide the most accurate explanation of all charges.
Patient will bear financial responsibility for all costs not covered by commercial insurance exceeding maximum benefit for YCANTH. THIS IS NOT INSURANCE.
Patients with insurance, in whole or in part, from Medicaid, Medicare, VA, Department of Defense ("DOD"), TRICARE (TRICARE^® is a registered trademark of DOD), DHA, or other federal or state programs including any state pharmaceutical assistance programs, are not eligible to participate in the YCANTH Copay Assistance Program.

The YCANTH Copay Assistance Program card is not transferable. No substitutions are permitted. Cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer not already associated with this offer.
This Program is not valid where prohibited by law, taxed, or restricted.
Verrica Pharmaceuticals reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms of use at any time without notice.
Additional terms and conditions may apply.
Approval of enrollment in the Program is not guaranteed.

De-identified patient data related to redemption of the YCANTH Copay Assistance Program may be collected, analyzed, and shared with Verrica Pharmaceuticals, for market research and other purposes related to assessing patient savings programs. The patient understands they are consenting to allow Verrica Pharmaceuticals and its contracted vendor InfinityRx to store all collected personal and medical information for the administration of this program. For questions call: 888-927-3499. The healthcare information contained herein is not intended to replace discussion with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient.

INDICATION

YCANTH^® (cantharidin) topical solution, 0.7% is indicated for the topical treatment of molluscum contagiosum in adult and pediatric patients 2 years of age and older.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS: None.

WARNINGS AND PRECAUTIONS:

YCANTH is for topical use only. YCANTH is not for oral, mucosal, or ophthalmic use. Life threatening or fatal toxicities can occur if YCANTH is administered orally. Avoid contact with the treatment area, including oral contact, after treatment. Ocular toxicity can occur if YCANTH comes in contact with eyes. If YCANTH gets in eyes, flush eyes with water for at least 15 minutes.
Local Skin Reactions: Reactions at the application site may occur, including vesiculation, pruritus, pain, discoloration, and erythema. Avoid application near eyes and mucosal tissue, and to healthy skin. If YCANTH contacts any unintended surface, or healthy skin, immediately remove. If severe local skin reactions occur, remove prior to the recommended 24 hours after treatment.
YCANTH is flammable, even after drying. Avoid fire, flame or smoking near lesion(s) during treatment and after application until removed.

ADVERSE REACTIONS:

The most common (incidence ≥1%) reactions are the following local skin reactions at the application site: vesiculation, pain, pruritus, scabbing, erythema, discoloration, application site dryness, edema, and erosion. Local skin reactions at the application site were observed in 97% of subjects treated with YCANTH during clinical trials. These local skin reactions are expected and related to the anticipated blistering response of the skin to cantharidin.

DRUG INTERACTIONS:

No studies evaluating the drug interaction potential of cantharidin have been conducted.

USE IN SPECIFIC POPULATIONS:

Pregnancy: There are no available data with use of YCANTH in pregnant women to evaluate for a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Given that systemic exposure to cantharidin following topical administration is low, maternal use is not expected to result in fetal exposure to the drug.

Lactation: Avoid application of YCANTH topical solution to areas with increased risk for potential ingestion by or ocular exposure to the breastfeeding child.

OVERDOSAGE:

Oral ingestion of cantharidin has resulted in renal failure, blistering and severe damage to the gastrointestinal tract, coagulopathy, seizures, and flaccid paralysis.

Please see full Prescribing Information.

To report SUSPECTED ADVERSE REACTIONS, contact Verrica Pharmaceuticals Inc. at 1-877-VERRICA (1-877-837-7422), or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. Local skin reactions are expected and should be reported if they are severe.

References: 1. Centers for Disease Control and Prevention. Molluscum contagiosum: treatment options. Accessed March 12, 2024. https://www.cdc.gov/poxvirus/molluscum-contagiosum/treatment.html 2. Eichenfield LF, McFalda W, Brabec B, et al. Safety and efficacy of VP-102, a proprietary, drug-device combination product containing cantharidin, 0.7% (w/v), in children and adults with molluscum contagiosum: two phase 3 randomized clinical trials. JAMA Dermatol. 2020;156(12):1315-1323. doi:10.1001/jamadermatol.2020.3238 3. YCANTH (cantharidin) topical solution 0.7% Prescribing Information, Verrica Pharmaceuticals Inc., 2024.

FDA=Food and Drug Administration.