Iluvien Patient Assistance Program

Funded

About

The Iluvien Patient Assistance Program is dedicated to providing the drug Iluvien free of charge to eligible patients who are either uninsured or lack coverage for Iluvien. With a focus on those with financial needs, the program ensures that patients and their physicians can complete a straightforward application process, facilitating access to necessary treatment with Iluvien. This commitment underscores the Iluvien Patient Assistance Program's role in supporting patients in the U.S. and Puerto Rico by assisting those with limited financial means, boosting access to Iluvien and making a positive impact on eligible patients' lives.

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

•Provides ILUVIEN free of charge to eligible patients who are uninsured or lack coverage for ILUVIEN

•Patient must have a financial need

•Patient must complete the Patient Assistance Program application with physician

•Fax the completed and signed PAP application to AccessPlus at 1 844 501 7161, application will be reviewed and decision will be made within 5 days

•If eligible, patient and physician will receive a letter indicating approval to proceed with scheduling injection appointment

•Patients may need to provide proof of income for their household with documentation such as current tax returns, 1099s, employer letter of income, W2, or pay stubs

•Program does not provide assistance for the injection procedure, diagnostic tests or other costs associated with the administration of ILUVIEN.

Enrollment Forms

Enrollment Form