Apellis Trial Offer Program: Empaveli
Funded
About
The Apellis Trial Offer Program: Empaveli provides eligible patients with access to the drug Empaveli at no cost for 8 weeks. This program is designed to facilitate a trial period for patients prescribed Empaveli for an FDA-approved indication, enhancing their treatment options without financial burden. The Apellis Trial Offer Program: Empaveli ensures patients have support and resources available during their trial, maximizing the benefit and accessibility of this innovative therapy.
Insurance requirements: Commercially insured, Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Benefits
•1 maximum fills per year
Program Requirements
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible patients may receive Empaveli for 8 weeks at no cost
•HCP must fax completed EMPAVELI Trial Offer Start Form to 18887541285
•Patients may only enroll in the Trial Offer Program one time
•There is no obligation for patients to continue use of EMPAVELI after the program has been completed
•Patients currently taking EMPAVELI or who have previously taken EMPAVELI are not eligible for the the program
•For more information, visit EMPAVELI.com
•Call an ApellisAssist representative at 1866MYAPLASSIST (18666927527) from 8 am8 pm ET, MondayFriday, to speak with a 24hour oncall pharmacist
Enrollment Forms
Enrollment Form