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