Diacomit Quick Start Program

Funded

About

The Diacomit Quick Start Program offers significant benefits for newly eligible patients by providing up to 60-day access to Diacomit at no cost. This program ensures that patients with private or commercial insurance, prescribed Diacomit for an FDA-approved indication, can quickly initiate their treatment even when facing access delays. The Diacomit Quick Start Program is specifically designed to support patients in the United States, enhancing timely therapeutic intervention with Diacomit, and ensuring healthcare providers have a streamlined process to assist their patients effectively.

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 up to 60day fulfillment of DIACOMIT at no cost to the patient

•For newly eligible patients experiencing delays in gaining access to therapy

•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