Afstyla Co-Pay Assistance Program
Not Funded
About
The Afstyla Co-Pay Assistance Program provides significant financial support for Afstyla users, with an annual benefit of up to $12,000. Patients with private insurance can benefit from the program to cover costs not fully compensated by their insurer, such as deductibles and co-payments. The Afstyla Co-Pay Assistance Program requires patients to be U.S. residents with private insurance coverage for Afstyla, making it an invaluable resource for reducing out-of-pocket expenses on this essential medication.
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
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Annual benefit is up to $12,000 per enrollment year (no monthly maximum limit)
•Benefits may be claimed only for product costs not covered by the patient’s commercial insurer such as: a deductible, copayment, or coinsurance
•Patients can begin enrollment process by calling 18006764266 (MondayFriday 8 AM8 PM ET) to check eligibility, then download and complete the enrollment form
•Forms should be completed by patient and doctor, and faxed to 18447272757
Enrollment Forms
Enrollment Form