Diacomit Copay Program

Funded

About

The Diacomit Copay Program offers significant financial assistance for patients prescribed Diacomit, potentially allowing them to pay as little as $0 for their prescriptions. To benefit from the Diacomit Copay Program, healthcare providers must fax the necessary prescription and form. For more details, the Diacomit Patient Access Program can be reached for support and inquiries.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Patient may pay as little as $0 per prescription

•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