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Patient Assistance Information

 
 
 
Zyflo Connect Co-Pay Program


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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