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Saizen Easy Savings Program
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Phone
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(800)582-7989
Fax:
(877)408-4288
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Eligibility
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This program is intended for patients who may have insurance, but NOT have Medicaid. Medicare Part D patients are not eligible for this program. No income limits. MA residents are not eligible for this program. |
| Who Can Apply
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The Doctor should call for an application or download it from the website. Application must be faxed back to company from Doctor's office. Patient and Doctor are notified of decision. |
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Required
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Must have FDA approved diagnosis. Doctor must complete and fax Statement of Medical Necessity and signed Patient Authorization forms which are on the website. Patients just informs Doctor that he/she is in need. |
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Supply
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Amount/supply varies. Refill process not applicable. Refill limit maximum of 12 times in one year. Re-application process not applicable. |
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Ship To
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Shipping location not applicable. |
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Note
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Patients must not have filled a Saizen prescription in the past 6 months.
After program activation, patients can save up to $200 per month on monthly copay or coinsurance costs for 12 months.
This program runs and renews on an annual basis. |
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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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| Saizen injection |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Saizen Easy Savings Program |
(Requires Acrobat Reader) 
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