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Patient Assistance Information

 
 
 
Afrezza Co-Pay Support Program


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Phone : 866-991-2840
Fax: 855-834-3468
Eligibility
> Patients must have no insurance and have a medically appropriate diagnosis/condition.
Who Can Apply
> Patient or healthcare providers can call to complete the application by phone or complete the application online.
Required
> Patients must call or enroll online. Doctors must provide a prescription.
Supply
> Not applicable
Ship To
> Patient is sent savings card to be used at pharmacy.
Note
> 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.
 
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.
 
Afrezza powder; inhalation
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader