Alprolix Free Trial Plus Program
Funded
About
The Alprolix Free Trial Plus Program offers a valuable opportunity for eligible patients to access the drug Alprolix through a free trial. Designed specifically for US or Puerto Rico residents, the Alprolix Free Trial Plus Program provides your first 30-day supply of Alprolix at no cost with a valid prescription. This program aims to support patients by ensuring they receive their medication while navigating access issues. Enjoy the benefits of the Alprolix Free Trial Plus Program and experience the therapeutic benefits of Alprolix with ease and efficiency.
Insurance requirements: Commercially insured, Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Benefits
•1 maximum fills per year
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
•Patients can receive their first 30day supply of ALPROLIX with a valid prescription from their healthcare provider
•Patients may also be eligible to receive free factor for a limited period of time, while Patient Services addresses their factor access issue
•Patient must download, complete, and sign the enrollment Form and bring it to physician who should fax the form to 18553987634
Enrollment Forms
Enrollment Form