Kisunla Savings Card Program

Funded

About

The Kisunla Savings Card Program offers a valuable opportunity for individuals prescribed the drug Kisunla. This program can significantly reduce out-of-pocket expenses for eligible patients by lowering copays to as little as $0 per infusion. The Kisunla Savings Card Program supports up to 15 infusions annually, emphasizing its commitment to making Kisunla more accessible to those with commercial insurance coverage.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$9450 annual maximum benefit

•15 maximum fills per year

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, commercially insured patients with coverage for Kisunla may pay as little as $0 copay for each infusion, up to a maximum of 15 infusions

•Card savings are subject to a maximum monthly savings of wholesale acquisition cost plus usual and customary fees and separate maximum annual savings of $9,450 per calendar year

•For enrolled patients, the Program may provide support for infusions with a date of service that falls within 120 days prior to the date the enrollment form is received by the Program

•HCP should fax completed enrollment form to 8447312697

•For assistance, call 8005455979, MondayFriday 9am – 6pm ET

Enrollment Forms

Enrollment Form