Diacomit Long-Term Patient Assistance Program

Funded

About

The Diacomit Long-Term Patient Assistance Program provides essential support for patients who need Diacomit. This program helps eligible uninsured or underinsured individuals access Diacomit at no cost, ensuring that patients can receive their necessary medication without financial burden. Contact the Diacomit Long-Term Patient Assistance Program for more information on eligibility and prescriptions.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible uninsured or underinsured patients may be able to receive DIACOMIT at no cost

•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