Palforzia Patient Assistance Program

Not Funded

About

The Palforzia Patient Assistance Program provides valuable support by offering the Palforzia drug product at no cost to eligible patients. This program is designed to assist those who meet specific insurance and financial criteria, ensuring access to Palforzia through a streamlined process managed by the Palforzia Pathway Support Program. By using the Palforzia Patient Assistance Program, patients can benefit from hassle-free access to the treatment they need.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•The Palforzia Pathway PAP will provide free product for patients who meet certain insurance and financial eligibility criteria

•Fax completed form to: 18447080011

•All patient referrals to this program must be routed through the Hub (PAP administrators will not take direct referrals from Specialty Pharmacies)

•SPs can contact 9198824616, 8am to 8pm EST

•For more information, call 1844PALFORZ (18447253679), option 2

Enrollment Forms

Enrollment Form