Firazyr Sample Program

Funded

About

The Firazyr Sample Program offers a unique opportunity for eligible U.S. residents to receive a 30-mg dose of Firazyr, a prescription medication, at no cost as a trial. Designed for adults 18 and older, the program ensures that healthcare providers can easily request and receive a sample to help decide on the suitability of Firazyr for their patients. With its straightforward request process, the Firazyr Sample Program facilitates access for those in need.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

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

•If HCP decides patient should try FIRAZYR, he/she can take the next step by requesting a sample (doctor's can obtain one sample per qualified patient)

•A single 30mg (fullsize) dose of FIRAZYR will be delivered to HCP as a sample for a trial use at no cost to the patient

•HCP fills out the online form to request the sample; a FIRAZYR representative will contact them in 72 hours

•Contact the program at 8668880660 for more information

Enrollment Forms

Enrollment Form