Ilumya Patient Assistance Program

Funded

About

The Ilumya Patient Assistance Program offers a valuable opportunity for individuals prescribed Ilumya, ensuring those who are uninsured or underinsured can access this essential medication at no cost. Through the Ilumya Patient Assistance Program, eligible patients residing in the US, Guam, Puerto Rico, or the US Virgin Islands can receive Ilumya free of charge for an FDA-approved indication. This program underscores a commitment to accessibility and support for those who need it most.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible patients receive medication free of charge

•HCP can enroll patient online via the ILUMYA Provider Portal: https://www.ilumyasupport.com/ilumyasupportprovider/ or download and fax the PDF application

•All sections of the enrollment form must be completed and signed by the patient and physician

•Enrollment is good for 12 months from the date of approval; patients must submit a new application yearly to reenroll

•Call 8554458692, Monday through Friday, 8 AM to 8 PM ET, for assistance or additional information

Enrollment Forms

Enrollment Form