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Afrezza Co-Pay Support Program
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Phone
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866-991-2840
Fax:
855-834-3468
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Eligibility
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Patients must have no insurance and have a medically appropriate diagnosis/condition. |
| Who Can Apply
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Patient or healthcare providers can call to complete the application by phone or complete the application online. |
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Required
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Patients must call or enroll online. Doctors must provide a prescription. |
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Supply
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Not applicable |
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Ship To
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Patient is sent savings card to be used at pharmacy. |
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Note
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Afrezza® Patient Savings Card: Pay $0 for the first prescription. After that, pay no more than $30 for each prescription refill, depending on your insurance coverage.
With each prescription, receive 2 inhalers and a month’s supply of cartridges. |
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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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| Afrezza powder; inhalation |
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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 |
(Requires Acrobat Reader) 
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