Cinqair Cost Support Program

Funded

About

The Cinqair Cost Support Program offers meaningful financial support by significantly reducing the cost burden for patients prescribed Cinqair. With the Cinqair Cost Support Program, eligible patients can enjoy $0 medication and administration costs, freeing them from the financial stress associated with treatment. The Cinqair Cost Support Program ensures continual support with automatic re-enrollment and substantial annual savings assistance capped at $10,000.

Insurance requirements: Commercially insured

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: Yes

Program Details

•$0 medication costs per dose & $0 administration costs per treatment

•Eligible patients receive a maximum of $10,000 savings assistance per calendar year; January 1 through December 31.

•Program helps with copays, coninsurance, and deductibles (does not cover costs of physician office visits or evaluations, blood work or other testing, or transportation)

•Patient or patient's health care provider must submit a program claim form and EOB from the patient's commercial insurance plan with details on patient's OOP

•Patients enrolled in the program are automatically enrolled in the program for next calendar year unless they choose to opt out

•For questions or assistance, please call Teva Support Solutions, Monday–Friday, 9am5:30pm EST at 18448382211

Enrollment Forms

Enrollment Form