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AccessConnect for Zydelig
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Phone
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(844)622-2377
Fax:
(855)553-8672
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Eligibility
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Must have no prescription coverage for needed medication. Medicare Part D patients are eligible, but contact program fro details. Income requirements not disclosed. Must be a US resident and treated by a US licensed healthcare provider. |
| Who Can Apply
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Call for prescreening and have application faxed. Return application via fax. Call for decision which could take up to 10 days. |
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Required
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Diagnosis/medical criteria required to be medically Necessary as determined by a Doctor. Doctor must complete and sign application. Patient must complete application, sign, attach copies of proof of income, residency and other requested documentation. |
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Supply
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Up to 30 day supply. Patient contacts pharmacy for refills. Contact the program for refill limit details. New application to be completed yearly. |
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Ship To
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Ships to Patient's home within 4-10 business days. |
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Note
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The ZYDELIG QuickStart Program provides a free 30-day supply for eligible patients who face an insurance coverage delay of more than 5 business days.
This program also provides copay assistance for insured patients. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Zydelig tablet |
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