Palforzia Pathway Co-Pay Savings Program

Not Funded

About

The Palforzia Pathway Co-Pay Savings Program offers substantial financial assistance for patients taking Palforzia, ensuring they pay as low as $20 per month. This program supports eligible patients in managing their healthcare expenses, making the FDA-approved Palforzia more accessible. The Palforzia Pathway Co-Pay Savings Program simplifies the process with easy enrollment and renewal options, providing ongoing support for users of Palforzia.

Insurance requirements: Commercially insured

As low as: $20 per mo

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

•Eligible patients may pay as low as $20 per month

•Annual maximum benefit applies; patient outofpocket expense varies; after the annual maximum benefit is reached, the patient or legal guardian will be responsible for all PALFORZIA outofpocket costs

•SPs may assist potentially eligible commercially covered patients with enrolling in the program as long as the parent/legal guardian has confirmed the desire to enroll

•Alternatively, the SP can inform the patient's parent/legal guardian of the publicly available URL for the copay enrollment website

•Once enrolled, patients can print or download the Savings Card, which includes the card number

•Patients enrolled in the program must reapply by the 12month anniversary of their current enrollment if they wish to continue participating in the program

•When calling the patent/caregiver to arrange delivery of Palforzia, the SP will apply the card to lower the Palforzia outofpocket costs

•SPs should should also make a note of patient's card number to apply to future Palforzia refills

•For processing queries, SPs can call 8554346274, 8am8pm EST

Enrollment Forms

Enrollment Form