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Patient Assistance Information

 
 
 
Saizen Easy Savings Program


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Phone : (800)582-7989
Fax: (877)408-4288
Eligibility
> 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
> 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.
Required
> 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.
Supply
> Amount/supply varies. Refill process not applicable. Refill limit maximum of 12 times in one year. Re-application process not applicable.
Ship To
> Shipping location not applicable.
Note
> 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.
 
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.
 
Saizen injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Saizen Easy Savings Program
(Requires Acrobat Reader