Orbactiv Copay Savings Program

Funded

About

The Orbactiv Copay Savings Program offers significant cost reduction for patients prescribed Orbactiv, with eligible commercially insured patients paying as little as $50 per treatment. The Orbactiv Copay Savings Program provides a maximum benefit of $600, making access to Orbactiv more affordable. Designed with patient convenience in mind, the Orbactiv Copay Savings Program facilitates the copayment process through a straightforward form submission and virtual debit card system.

Insurance requirements: Commercially insured

As low as: $50 per fill

Enrollment Forms

Enrollment Form

Benefits

•$600 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible commercially insured patients may pay as little $50 per treatment

•Maximum benefit of $600

•Patient and HCP must complete form and fax to 8558862482

•Patient must provide email address to receive virtual debit card information for copay payments

•Call 8446722284, Monday through Friday, 8am – 8pm ET, for assistance or additional information

Enrollment Forms

Enrollment Form