ONWARD Copay Assistance Program: Fintepla

Funded

About

The ONWARD Copay Assistance Program: Fintepla is designed to provide financial relief for eligible patients who require Fintepla medication. By participating in the ONWARD Copay Assistance Program, patients may significantly reduce their out-of-pocket expenses, ensuring that cost is not a barrier to accessing necessary treatment. The program ensures that eligible patients pay no more than $25 for their prescriptions, making Fintepla more affordable and accessible.

Insurance requirements: Commercially insured

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

•Eligible patients may pay no more than $25 in outofpocket costs for their prescriptions

•Program helps with copayments, deductibles, or coinsurance

•Both the Prescription Authorization and Patient Referral Form and the REMS Patient Enrollment form (located https://www.fintepla.com/wpcontent/themes/fintepla/img/REMS_Patient_Enrollment_Form.pdf) need to be submitted; fax to 8882506103 or upload to the Provider Portal (ONWARDProviderPortal.com)

•For more information, call 8889643649 7am7pm Central Time, MondayFriday

Enrollment Forms

Enrollment Form