Sunovion Support Prescription Assistance Program: Aptiom

Not Funded

About

The Sunovion Support Prescription Assistance Program: Aptiom offers eligible patients vital access to the drug Aptiom at no cost. This program primarily supports patients with a valid prescription by providing up to 12 months of medication. Designed to assist those without prescription coverage, the program ensures patients in the United States, Puerto Rico, or the U.S. Virgin Islands, with specific income eligibility, can receive much-needed support. For those who qualify, the Sunovion Support Prescription Assistance Program: Aptiom removes financial barriers to medication access, ensuring continuity of care without added financial stress.

Insurance requirements: 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

•Eligible patients who have a valid prescription can receive up to 12 prescription fills (equivalent to 12 months of assistance annually) at no cost

•Patient must mail the completed application form, your prescription, and proof of income to: Sunovion Support® PO Box 220285, Charlotte, NC 282220285 or fax to: 18778500821

•Patient must have no prescription coverage

•If patient qualifies an Sunovion Support® Specialist. will contact patient and healthcare professional or if the application form is missing information or documents

•Remember to include patient and doctor signature, proof of income and patient’s prescription. If you have any questions or need help filling out this form, please contact us at (877) 8500819 or visit www.sunovionsupport.com

Enrollment Forms

Enrollment Form