Amicus Copay Assistance Program: Pombiliti + Opfolda

Funded

About

The Amicus Copay Assistance Program: Pombiliti + Opfolda offers substantial financial assistance for eligible patients prescribed Opfolda & Pombiliti. With this program, patients with private insurance can potentially lower their treatment costs significantly each month, ensuring more affordable access to necessary medications.

Insurance requirements: Commercially insured

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, commercially insured patients may pay as little as $0 per month for treatment

•HCP should fax completed Patient Referral Form to 18336264291

•Copay assistance is subject to annual maximum limits

•Infusionrelated costs are not covered for individuals residing in RI

•For more information, call 18332642872, Monday through Friday 8AM to 8PM ET or visit www.AMICUSASSIST.com

Enrollment Forms

Enrollment Form