Kisunla Savings Card Program - Covered benefit

Coverage RequiredFunded

About

The Kisunla Savings Card Program - Covered benefit offers significant financial assistance for patients prescribed Kisunla. It helps eligible, commercially insured patients pay as little as $0 copay for Kisunla infusions, making the treatment more accessible and affordable. With a maximum of 15 infusions and potential annual savings up to $9,450, the Kisunla Savings Card Program is an invaluable resource for reducing healthcare costs associated with Kisunla.

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: Yes

•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

Enrollment Forms

Enrollment Form