Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
2 Programs for Zyflo CR tablet; extended release
 
 
Zyflo Connect Co-Pay Program


,
Phone : 844-699-9356
Fax:
Eligibility
> This program is intended for patients that are uninsured or are underinsured. Medicare Part D patients are not eligible for this program. Patients must be a US resident or resident of Puerto Rico. Income requirements for this program have not been disclosed.
Who Can Apply
> Patient must call to enroll once Doctor gives them the prescription. No online application available.
Required
>
Supply
> 30 day supply. Refill limit, refill process and re-application not specified.
Ship To
> Medication will be sent to Patient's home.
Note
> Out-of-pocket benefit equals an amount up to $2,500 per month with a maximum benefit of $30,000 per year. If a patient exceeds the maximum monthly benefit of $2,500, the patient will be responsible for the outstanding balance. This program expires December 31, 2016
 
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.
 
Zyflo CR tablet; extended release
 
 
 
Zyflo Connect Patient Assistance Program


,
Phone : 844-699-9356
Fax:
Eligibility
> Uninsured or Underinsured with no prescription coverage. Medicare part D eligibility is determined case by case. Income requirements for this program have not been disclosed. Patient must be a US citizen or legal entrant.
Who Can Apply
> Doctor/Doctor's office must call to request application, which will be sent to the Doctor's office and must be faxed back from the Doctor's office. No online application available.
Required
> Doctor must complete section and sign. Patient must complete section, sign, attach proof of income and other requested documentation. Patient and Doctor will be notified of acceptance.
Supply
> Amount/supply not specified.
Ship To
> Medication will be shipped to Patient's home in 1-2 business days. Refills are automatically sent out and patient must complete a new application every 12 months.
Note
> Resources for HEALTHCARE PROFESSIONALS ONLY. Physician must call to obtain an enrollment form.
 
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.
 
Zyflo CR tablet; extended release