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Horizon UCD Support Services
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Phone
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855-823-7878
Fax:
877-695-8304
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Eligibility
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The Horizon UCD Support Services program is for patients that have no prescription coverage, have reached a cap, or cannot afford the co-payment. Patients with Medicare Part D are eligible if the medication is not covered by their plan. The patient must be a resident of the US. Patients must have a Urea Cycle Disorder (UCD). |
| Who Can Apply
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Patients and doctors can apply by obtaining an application by phone or by downloading from the link below. |
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Required
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The application must be completed and signed by the physician and patient. A copy of the patients insurance information must be attached. |
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Supply
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Supply varies. |
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Ship To
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Medication is shipped to the patient's home and patient will contact the pharmacy for re-fills. |
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Note
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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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| Buphenyl tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
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