Epidiolex JazzCares QuickStart Program

Funded

About

The Epidiolex JazzCares QuickStart Program provides a valuable opportunity for new patients diagnosed with Lennox-Gastaut syndrome, Dravet syndrome, or tuberous sclerosis complex to receive Epidiolex, an important drug product, while insurance coverage is being pursued. This program is specifically designed to assist patients with commercial insurance or those eligible for federal healthcare programs, by offering up to four 15-day supplies of Epidiolex at no cost. The Epidiolex JazzCares QuickStart Program ensures patients have access to their medication during critical initial treatment periods, though it comes with a one-time usage limit per patient.

Insurance requirements: Commercially insured, Medicare / Medicaid

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible patients can get EPIDIOLEX through the Quick Start Program while coverage is being pursued

•New patients may be eligible to receive up to four 15day free supplies

•There is a lifetime limit of one Quick Start per patient

•Instructions to enroll patients in program (for HCP):

•Complete the Patient Support Program Start Form, making sure to check the two boxes at the top, sign the HCP or designated agent authorization, and obtain patient or legal guardian signature

•Fax the completed form and valid prescription to Epidiolex Engage™ at 18555187566

•Submit eRX to PharmaCord 11001 Bluegrass Parkway, Suite 200, Louisville, KY 40299

•Tell the caregiver to expect a call from the Epidiolex Engage team

•For more information, call 1833GBNGAGE (18334264243)

Enrollment Forms

Enrollment Form