Adbry Patient Assistance Program

Funded

About

The Adbry Patient Assistance Program provides an excellent opportunity for eligible individuals to receive the drug Adbry at no cost. Designed for those with limited or no prescription insurance coverage, this program ensures access to Adbry for managing FDA-approved indications. The Adbry Patient Assistance Program offers significant benefits, including coverage for eligible patients either without Medicare Part D or until the end of the Medicare coverage year, making access to Adbry more affordable and accessible.

Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Patient must have financial need and have limited or no prescription coverage, you may be able to receive Adbry at no cost

•Eligible patients without Medicare Part D coverage will receive up to twelve months without charge from the date of enrollment; eligible patients with Medicare Part D coverage will receive product through the end of the coverage year

•If the patient may be eligible for Medicaid, then the patient is required to provide documentation of Medicaid denial before being assessed for Program eligibility

•The patient either:

•(a) has Medicare Part D coverage and has applied for and been denied the Low Income Subsidy (LIS) from the Social Security Administration and meets the further conditions below; or

•(b) has no insurance coverage, no benefits for prescription medicines, or the patient’s insurance plan has formally denied coverage for the product through a written coverage policy or a written decision as part of a benefits inquiry or prior authorization process and has provided a copy of the denial

•HCP should fax completed Enrollment and Prescription Form to: 8554230011

•HCP may also complete the digital enrollment form or submit an eRx at https://adbryerx.com/#/

•Call 8446923279, MondayFriday, 8AM8PM ET, for assistance or additional information

Enrollment Forms

Enrollment Form