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Patient Assistance Information

 
 
 
Zyflo Connect Patient Assistance Program


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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