Dompé CONNECT to Care Copay Program: Oxervate

Funded

About

The Dompé CONNECT to Care Copay Program: Oxervate offers significant financial assistance for eligible patients prescribed Oxervate, a vital FDA-approved drug. By enrolling in this program, patients with commercial insurance may reduce their out-of-pocket costs to no more than $100 for an 8-week course of therapy. The program extensively supports participants in managing co-payments, ensuring necessary treatment remains accessible and affordable.

Insurance requirements: Commercially insured

As low as: $100 per fill

Enrollment Forms

Enrollment Form

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

•Program will determine eligibility for Oxervate copay card

•Patient & HCP must complete and fax enrollment form for each new prescription and fax to Dompé Connect to Care at 18552631775

•Copies of front and back of all insurance cards must also be submitted

•Program can also arrange support delivery and administration of Oxervate

•For more information HCPs can call 18774224412

•With Dompé copay support, a majority of patients with commercial insurance who were prescribed OXERVATE paid no more than $100 outofpocket for an 8week course of therapy

Enrollment Forms

Enrollment Form