PiaSky Co-pay Program

Funded

About

The PiaSky Co-pay Program offers significant benefits for patients prescribed PiaSky. It allows eligible commercially insured patients to pay as little as $0 out-of-pocket, ensuring affordability and ease of access to the drug product. The PiaSky Co-pay Program automatically renews annually, guaranteeing continuous support for patients under the program.

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: No

Program Details

•Eligible commercially insured patients may pay as little as $0 outofpocket, up to a maximum annual limit

•The maximum Program benefit will reset every January 1st; eligible patients will be automatically reenrolled in the Program on an annual basis

•Once a patient is enrolled, the Program will honor claims with a date of service that precedes the Program enrollment date up to 180 days

•HCP may submit Prescriber Service Form online, or fax to 8664807762

•Patient Consent Form is also required and may be submitted online or faxed to 8664807762

•For assistance or additional information, call 8664222377, MondayFriday, 6am5pm PT

Enrollment Forms

Enrollment Form