IncyteCARES for Pemazyre Savings Program

Funded

About

IncyteCARES for Pemazyre Savings Program provides significant financial assistance for patients prescribed Pemazyre, allowing eligible participants to pay as little as $0 per month. The program targets patients with commercial insurance, helping manage out-of-pocket expenses for FDA-approved indications of Pemazyre.

Insurance requirements: Commercially insured

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: Yes

Program Details

•Eligible patients pay as little as $0 per month; limit one 30day supply per 30 days

•Patient must have a minimum outofpocket expenses of $0.01 to redeem this offer

•Patients will be responsible for any outofpocket costs above the maximum annual and monthly program benefit

•Card is valid through December 31 of the year of activation; On January 1 of the following year, the card automatically resets and is subject to annual limits if the prescription benefit remains the same

•For assistance or additional information, call 8554525234, Monday through Friday, 8 am–8 pm ET

Enrollment Forms

Enrollment Form