Evrysdi Co-pay Program

Funded

About

The Evrysdi Co-pay Program is designed to provide significant financial assistance for patients prescribed Evrysdi, ensuring they receive their medication with minimal out-of-pocket costs. The Evrysdi Co-pay Program offers eligible patients the opportunity to pay as little as $0 for each prescription, with a maximum annual benefit of $25,000. This program is an ideal solution for patients with commercial insurance who meet the eligibility criteria, making Evrysdi more accessible to those in need.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$25000 annual maximum benefit

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 commercially insured patients may pay as little as $0 for each prescription

•Maximum benefit of up to $25,000 per calendar year

•Patients or HCP may apply online and receive copay information immediately upon approval

•Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days

•Claims must be submitted within 365 days from the date of service unless otherwise indicated

•For assistance or additional information, call 8333879734 (Monday–Friday, 9 a.m. to 8 p.m. ET)

•For help processing the coupon or for patient eligibility questions, call 8006360316

Enrollment Forms

Enrollment Form