Adstiladrin Copay Program

Funded

About

The Adstiladrin Copay Program offers significant financial assistance for patients prescribed Adstiladrin for an FDA-approved indication. Through the Adstiladrin Copay Program, eligible patients with private insurance can reduce their out-of-pocket costs significantly, potentially paying as little as $100. With a maximum benefit of $12,000 per claim, the Adstiladrin Copay Program is a valuable resource for managing healthcare expenses associated with the use of Adstiladrin.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$12000 annual maximum benefit

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: No

•Activation Required: No

Program Details

•Eligible, commercially insured patients may pay as little as $100 of their copay, coinsurance, or deductible

•Maximum benefit of $12,000 per claim

•HCP or SP should complete patient enrollment at https://hcp.ferringcopay.com/

•Call 8446236669, Monday to Friday, 9 am to 6 pm Eastern Time, for assistance or additional information

Enrollment Forms

Enrollment Form