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Patient Assistance Information

Horizon UCD Support Services

Phone : 855-823-7878
Fax: 877-695-8304
> 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
> Patients and doctors can apply by obtaining an application by phone or by downloading from the link below.
> The application must be completed and signed by the physician and patient. A copy of the patients insurance information must be attached.
> Supply varies.
Ship To
> Medication is shipped to the patient's home and patient will contact the pharmacy for re-fills.
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.
Buphenyl powder
Buphenyl tablet
Ravicti liquid
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
Download printable Form
(Requires Acrobat Reader