Izervay My Way Patient Assistance Program

Funded

About

The Izervay My Way Patient Assistance Program is designed to help patients access Izervay, whether they are uninsured or underinsured. With Izervay prescription support, the program ensures that eligible patients can receive their necessary treatment without the burden of high costs. By offering comprehensive access through a simple enrollment process, the Izervay My Way Patient Assistance Program stands out as a vital resource for patients requiring Izervay therapy.

Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

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: Yes

•Activation Required: No

Program Details

•Help underinsured or uninsured patience gain access to Izervay

•Once enrolled, an Access Coordinator will call patient

•HCP can either enroll patient through online portal, or by downloading the enrollment form (https://www.izervayecp.com/docs/USAP2400436IZERVAYMyWayEnrollmentForm.pdf) and either email it to support@izervaymyway.com or fax it to 18332569929

•Uninsured patients, commercially insured patients, and federal healthcare program beneficiaries who qualify for the Astellas Patient Assistance Program are enrolled for the entire calendar year. However, Astellas reserves the right to reassess eligibility for uninsured patients and patients with commercial insurance during the enrollment period

Enrollment Forms

Enrollment Form