Nubeqa Free Trial

Funded

About

The Nubeqa Free Trial offers eligible patients the opportunity to try Nubeqa at no cost for up to 30 days. The program is designed to help those new to Nubeqa begin their treatment without financial burden. By providing the drug product Nubeqa free, the Nubeqa Free Trial aims to facilitate access and ease the initiation of therapy for qualified individuals residing in the United States or Puerto Rico.

Insurance requirements: Commercially insured, 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: No

•Activation Required: No

Program Details

•The NUBEQA Free Sample Program provides NUBEQA at no cost for up to 30 days to eligible patients

•Patients must be new to NUBEQA, not currently using it or previously received NUBEQA through a Free Trial Offer

•The program is available to all eligible patients, irrespective of drug coverage

•Patient Service Request form can be faxed to: 8003901826

•For more information, call Access Services at 18002888374, MondayFriday, 9:00am6:00pm ET

Enrollment Forms

Enrollment Form