Faslodex Co-pay Savings Program

Funded

About

The Faslodex Co-pay Savings Program provides patients with significant financial relief, allowing eligible participants to pay as little as $0 per dose for the medication Faslodex. This program covers out-of-pocket costs up to $6,000 annually, making it an excellent option for those with commercial insurance in the US and Puerto Rico. Enroll today to take advantage of these outstanding benefits offered by the Faslodex Co-pay Savings Program.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

Benefits

•$6000 annual maximum benefit

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

•Eligible patients may pay as little as $0 per dose, program pays remaining outofpocket costs up to a maximum of $6,000 per year

•Patients may be contacted by a pharmacy or HCP with outofpocket cost; eligible patients can ask to be enrolled in the program or can enroll by contacting Access 360 at 18442752360

•Patient and HCP must complete form, sign and fax all pages to 18443292360

•HCP or Pharmacy may also enroll patients online at: https://www.myaccess360providerportal.com/

•For questions or assistance, please call Access 360, Monday through Friday, 8 am – 8 pm at 18442752360

•For any questions regarding Change Healthcare online processing, please call the Help Desk at 8002028319

Enrollment Forms

Enrollment Form