PROGRAM MAY NO LONGER BE AVAILABLE: Piqray Free Trial Program

Not Funded

About

The 'PROGRAM MAY NO LONGER BE AVAILABLE: Piqray Free Trial Program' offers eligible patients in the U.S. and Puerto Rico the opportunity to access a free 14-day supply of Piqray, a drug for FDA-approved indications. The program facilitates convenient access by shipping Piqray directly to patients' homes or another location, enhancing patient care with minimal barriers.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

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 be able to receive a free 14day supply of PIQRAY (for 300 mg and/or 250 mg only)

•The supply can be shipped directly to a patient’s home or another convenient location

•HCP should make sure to complete the section for the free trial program on the HCP Service Request Form

•Patient needs to complete the Patient Service Request Form

•The forms can be completed online, or downloaded and faxed to 18888914924

•For more information, please call 18002827630 from 8:00 am to 8:00 pm ET, Monday through Friday

Enrollment Forms

Enrollment Form