Libtayo Surround Patient Assistance Program
Funded
About
The Libtayo Surround Patient Assistance Program is designed to help patients access Libtayo, providing significant support to those who are uninsured, underinsured, or lack coverage for Libtayo. By offering free access to the drug for those who meet specific eligibility and income requirements, the Libtayo Surround Patient Assistance Program ensures that vital treatment is available to those in need across the US and its territories.
Insurance requirements: Medicare / Medicaid, 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 meet income requirements and are uninsured, lack coverage for Libtayo, or have Medicare Part B with no supplemental insurance coverage may receive LIBTAYO at no cost
•Enrollment can be by fax (8338538362) or by phone (patient and insurance details must be provided)
•A Libtayo Surround Reimbursement Specialist will send a confirmation letter to office/patient upon approval of patient enrollment
Enrollment Forms
Enrollment Form
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