Northera StarterRx Program

Funded

About

The Northera StarterRx Program is designed to support new patients by providing a free, one-time, 30-day supply of the drug Northera. This program is exclusively for new patients aged 17 and older who have a valid prescription for Northera and are covered by private or commercial insurance. The Northera StarterRx Program ensures that eligible patients can start their treatment promptly, easing the initial financial burden while confirming the treatment's FDA-approved indication.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Program Requirements

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•The StarterRx Program provides a onetime, 30day supply of NORTHERA to new, eligible, and commercially insured patients aged 17 years and older who have a valid NORTHERA prescription and an onlabel diagnosis

•HCP must fax completed Treatment Form to 8446010102, or may complete the form online

•Call 8446010101, Monday–Friday, 8 AM–6 PM EST, for assistance or additional information

Enrollment Forms

Enrollment Form