Izervay My Way Copay Program

Funded

About

The Izervay My Way Copay Program offers significant financial assistance for patients using the drug Izervay. Eligible commercial patients can reduce their treatment costs, potentially paying as little as $0. The Izervay My Way Copay Program ensures that patients with commercial insurance can receive vital financial support, up to a maximum of $20,000 annually for product costs and $1,500 for administration costs. Available in the US, the Izervay My Way Copay Program is an essential resource for reducing the financial burden of treatment for eligible participants.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$20000 annual maximum benefit

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 commercial patients may pay as little as $0 for their treatment

•There is a maximum benefit limit of $20,000 for product cost share per calendar year and $1,500 for the administration cost share reimbursement to the patient

•Patients are not eligible for the offer if they are selfpaying or if the patient is enrolled in a state or federal healthcare program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE

•Patients residing in Massachusetts and patients receiving IZERVAY treatment in Massachusetts are potentially eligible for copay assistance for the cost of IZERVAY only, and are not eligible for copay assistance for the administration of IZERVAY

•Patient questions and requests to discontinue participation in the program can be directed to 1888 C5MYWAY (18882569929) 8 AM to 8 PM ET Monday Friday

Enrollment Forms

Enrollment Form

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