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Zyflo Connect Patient Assistance Program
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Phone
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844-699-9356
Fax:
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Eligibility
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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
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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. |
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Required
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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. |
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Supply
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Amount/supply not specified. |
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Ship To
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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. |
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Note
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Resources for HEALTHCARE PROFESSIONALS ONLY.
Physician must call to obtain an enrollment form. |
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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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| Zyflo CR tablet; extended release |
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