Diacomit

(stiripentol)
stiripentol 250 MG Oral Capsule [Diacomit]stiripentol 250 MG Powder for Oral Suspension [Diacomit]
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NO BLACK BOX WARNING

Dosage & administration

Most viewed Diacomit resources

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drug label

Diacomit prescribing information

Need to report a Diacomit issue?

ONLINE FORM
Report adverse event
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prior authorization

Diacomit Prior authorization resources

Complete Letter of Medical Necessity

NOT PROVIDED BY BRAND
Coverage Authorization Request
Coverage Authorization Appeals
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Benefits investigation

Diacomit Patient Enrollment Form
Diacomit VA Patient Enrollment Form
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Reimbursement help (FRM)

NOT PROVIDED BY BRAND
Reimbursement help (FRM) resources
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financial assistance

Diacomit Financial assistance options

Co-pay savings program

commercial only
Diacomit Patient Enrollment Form
Enroll in Patient Savings Program
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Bridge program

commercial only
Diacomit Patient Enrollment Form
Enroll in Bridge Program
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Foundation programs

under insured
no insurance
goverment insurance
65+
Diacomit Patient Enrollment Form
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patient education

Diacomit Patient education

Getting started on Diacomit

NOT PROVIDED BY BRAND
Instructions For Use - Seizures due to Dravet's Syndrome

Patient toolkit

About Diacomit
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Caregiver Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
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Can't find what you're looking for?

Our trained staff can help you:
Please note:
  • Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
  • Samples are provided at the discretion of the brand.
  • We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.