Afstyla Free Trial Program

Not Funded

About

The Afstyla Free Trial Program offers an incredible opportunity for patients new to Afstyla, providing access to a free one-month trial or two acute doses for on-demand use. Designed specifically for those with a valid prescription for on-label use, this program aims to introduce new patients to the benefits of Afstyla. Whether insured privately or through Medicare and Medicaid, eligible patients can enjoy this risk-free trial, supported by the dedicated Afstyla Connect Case Manager team.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Patients with a valid prescription for onlabel use, receive free onemonth (30days) trial of AFSTYLA or two acute doses of AFSTYLA for ondemand trial

•No medical exceptions will be offered for the ondemand dosing program

•All insured patients who are new to AFSTYLA are eligible for the AFSTYLA Free Trial, including patients with Medicare and Medicaid

•Print and fax completed enrollment form to 18447272757

•For assistance, call an AFSTYLA Connect Case Manager 18006764266, Monday–Friday, 8 am to 8 pm ET

Enrollment Forms

Enrollment Form