R-Pharm US Access and Support Program

Funded

About

The R-Pharm US Access and Support Program offers a valuable opportunity for eligible US residents to access the drug Ixempra free of charge. This program is designed to support patients by providing medication and reimbursement assistance, ensuring that financial barriers do not prevent access to necessary treatments. The R-Pharm US Access and Support Program prioritizes ease of application and comprehensive support throughout the process.

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 Ixempra free of charge

•Fax (18775417813) or mail completed enrollment forms to: 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067

•Physician must also complete and sign second page of the enrollment form

•Forms must be submitted with financial documentation (e.g. tax return, pay stubs, etc)

•For reimbursement support, contact RPharm US Access and Support call 18559917277, 8 AM to 8 PM ET, Monday through Friday

Enrollment Forms

Enrollment Form