Mirum Access Plus: Cholbam QuickStart Assistance Program

Funded

About

The Mirum Access Plus: Cholbam QuickStart Assistance Program provides an exceptional benefit for patients needing Cholbam, ensuring timely access to medication despite insurance delays. The program is designed for patients experiencing insurance coverage delays, offering temporary 15-day supplies of Cholbam, which can be extended up to 60 days. The Mirum Access Plus program is a crucial support system for patients under the care of a licensed healthcare provider in the U.S. or Puerto Rico, empowering them with uninterrupted access to their prescribed medication.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

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

•Eligible commercially insured patients experiencing a delay in insurance coverage may be able to receive a temporary 15day supply of medication

•Patients continuing to seek or appeal a coverage determination from their insurer may be eligible to receive up to a maximum of three (3) additional 15day supplies, up to max 60 days aggregate

•HCP should fax completed enrollment form and any applicable documentation to 8552824884

•For assistance or additional information, call 8556764968, MondayFriday, 8am8pm ET

Enrollment Forms

Enrollment Form