Diacomit Bridge Program

Funded

About

The Diacomit Bridge Program offers significant advantages for eligible patients prescribed Diacomit, providing up to 60 days of free medication for those experiencing a lapse in insurance coverage. The Diacomit Bridge Program is an excellent resource for patients with private insurance and ensures continuous access to Diacomit during challenging insurance transitions.

Insurance requirements: Commercially insured, Underinsured, Uninsured

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

•Provides free fill up to 60 days at no cost to current patients experiencing a lapse in insurance coverage

•HCP must fax prescription and completed form to 833.871.4137

•For more information call DIACOMIT Patient Access Program at 8332480467, MondayFriday 8am8pm EST

Enrollment Forms

Enrollment Form