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Patient Assistance Information

 
 
 
AccessConnect for Zydelig


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Phone : (844)622-2377
Fax: (855)553-8672
Eligibility
> Must have no prescription coverage for needed medication. Medicare Part D patients are eligible, but contact program fro details. Income requirements not disclosed. Must be a US resident and treated by a US licensed healthcare provider.
Who Can Apply
> Call for prescreening and have application faxed. Return application via fax. Call for decision which could take up to 10 days.
Required
> Diagnosis/medical criteria required to be medically Necessary as determined by a Doctor. Doctor must complete and sign application. Patient must complete application, sign, attach copies of proof of income, residency and other requested documentation.
Supply
> Up to 30 day supply. Patient contacts pharmacy for refills. Contact the program for refill limit details. New application to be completed yearly.
Ship To
> Ships to Patient's home within 4-10 business days.
Note
> The ZYDELIG QuickStart Program provides a free 30-day supply for eligible patients who face an insurance coverage delay of more than 5 business days. This program also provides copay assistance for insured patients.
 
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.
 
Zydelig tablet