Assistance Fund: Gout

Funded

About

The Assistance Fund: Gout program offers financial support to eligible patients, providing copay, coinsurance, and deductible assistance for FDA-approved treatments such as Acthar Gel, Ilaris, Krystexxa, Betamethasone Sodium Phosphate & Betamethasone Acetate, Purified Cortrophin Gel, and Acthar Selfject. The program ensures that patients have access to medication by covering a range of out-of-pocket costs. Through the Assistance Fund: Gout program, eligible individuals can alleviate the financial burden of treatment while ensuring access to necessary medication.

Insurance requirements: Commercially insured, Medicare / Medicaid

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Please note the following:

•1. Copay grant programs provide assistance for copays, coinsurance, and deductibles for FDAapproved treatment for the disease named in the disease program ONLY

•2. Financial assistance grant programs provide assistance for other eligible outofpocket costs, such as health insurance premiums and incidental medical expenses, in addition to copay, coinsurance, and deductible assistance on FDAapproved treatment for the disease named in the disease program

•3. This fund may cover offlabel drugs

•Copay and Financial assistance can be utilized by any innetwork pharmacy or site of care able to dispense the medication or provide treatment

•Program offers conditional approval of 30 days of immediate assistance for open programs where funding is available

•Patients will be asked to provide and verify demographic, insurance, and financial information (additional documentation may be requested)

•Approved patients will be granted assistance through the end of the calendar year unless otherwise specified for the applicable program

Enrollment Forms

Enrollment Form