LEAP Patient Support Program: Letairis

Funded

About

The LEAP Patient Support Program: Letairis offers valuable assistance for patients prescribed Letairis, particularly those who are uninsured or underinsured. Through the Letairis Patient Assistance Program, eligible patients may access Letairis at no cost, provided certain conditions are met. This program not only supports access to essential medication but also ensures that patients remain informed and actively engaged in their health management through the necessary enrollment procedures.

Insurance requirements: Underinsured, Uninsured

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

•Eligible patients who are uninsured or underinsured may be able to receive Letairis free of charge through the Letairis Patient Assistance Program

•HCP and patient must complete the Letairis Prescription and LEAP Patient Support Enrollment Form and fax to 8888824035

•All female patients MUST complete the Patient Enrollment and Consent Form to enroll in the REMS Program prior to receiving treatment with Letairis

•REMS enrollment form can be downloaded from https://www.letairis.com/professional/enrollpatient and faxed to 8667509802

•Call 8666645327 for more information

Enrollment Forms

Enrollment Form