Gilotrif Bridge Program

Funded

About

The Gilotrif Bridge Program offers eligible patients a 15-day supply of the drug Gilotrif at no cost when they experience more than a 5-day delay in insurance coverage. This program assists patients with commercial insurance or Medicare Part D, ensuring continuity in treatment even during insurance transitions. Exclusively available in the United States, Puerto Rico, and US territories, the Gilotrif Bridge Program emphasizes seamless access to medication.

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 experiencing more than a 5day payer approval delay can receive a 15day supply of GILOTRIF at no cost

•HCP should fax completed prescription and enrollment form to 8884548488

•Call 18775465349 for assistance or additional information

Enrollment Forms

Enrollment Form