Jaypirca Interim Access Program

Funded

About

The Jaypirca Interim Access Program offers eligible patients a 15-day supply of Jaypirca at no charge while they experience insurance coverage delays. This program ensures patients can access their prescribed Jaypirca promptly, leveraging the support of the Lilly Oncology Support Center.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured

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: No

•Activation Required: No

Program Details

•The Jaypirca Interim Access Program provides a 15day supply of Jaypirca at no charge for eligible, insured patients who are prescribed Jaypirca for the first time and experiencing a minimum 5businessday delay in insurance coverage determination

•Not available to patients whose insurers have made a final determination to deny the patient coverage for Jaypirca

•If a denial is received after the initial 5 business days have passed and appeal rights are being pursued, or if there is a persistent coverage delay, the patient, under appropriate circumstances, may be eligible for up to 3 additional 15day supplies of Jaypirca

•HCP must fax completed form to 8555112515

•For more information, please call the Lilly Oncology Support Center at 18664728663, Monday—Friday, 8 AM—10 PM ET

Enrollment Forms

Enrollment Form