Assistance Fund: Primary Biliary Cholangitis

Not Funded

About

The Assistance Fund: Primary Biliary Cholangitis program offers financial support for patients prescribed with Ocaliva, Iqirvo, or Livdelzi. This program assists with copays, coinsurance, deductibles, health insurance premiums, and incidental medical expenses for FDA-approved treatments specifically for Primary Biliary Cholangitis. Eligible U.S. citizens or permanent residents benefit from comprehensive financial aid, ensuring treatment affordability and access to necessary medications.

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