Gilotrif Co-pay Assistance Program
Funded
About
The Gilotrif Co-pay Assistance Program provides significant benefits for patients prescribed Gilotrif. Eligible participants with private insurance can enjoy substantial reductions in monthly co-payments, ensuring that Gilotrif remains affordable and accessible. The program offers comprehensive support and potential savings, enhancing the patient experience through dedicated services and delivery options.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•16 maximum fills per year
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 commercially insured patients may pay as little as $0/month; maximum monthly savings may vary (subject to a maximum of 16 benefits per enrollment year)
•Restrictions, including monthly and yearly maximums, may apply
•Prescription transferred to Accredo and patient to schedule GILOTRIF delivery
•HCP should fax completed prescription and enrollment form to 8885692836
•SP may login to enroll eligible patients for copay card at: https://svc.opushealth.com/GilotrifSP/
•Call Gilotrif Patient Services at 18775465349 for assistance or additional information
•Gilotrif Dose Exchange covers up to 2 dose modifications for patients serviced through Accredo® who have 9 or more tablets to exchange
•For more information on the Gilotrif Dose exchange program, call 8445692836, Monday–Friday from 8am to 8pm EST
Enrollment Forms
Enrollment Form