Kyowa Kirin Cares Patient Assistance Program: Poteligeo

Funded

About

The Kyowa Kirin Cares Patient Assistance Program: Poteligeo offers support to individuals in need of the Poteligeo drug. This program is designed specifically for applicants who are permanent residents of the United States and entirely uninsured, ensuring they can access the necessary treatment prescribed by a licensed U.S. healthcare professional. Participants benefit from personalized eligibility assessments, helping more patients receive Poteligeo through the Kyowa Kirin Cares Patient Assistance Program.

Insurance requirements: Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Applicants will only be evaluated for eligibility upon receipt of a completed and signed Kyowa Kirin Cares PAP Application

•All areas of the form must be completed in full, including the Financial Information section & all signatures, and faxed to: 8442675848

•Each applicant will be individually assessed for program eligibility based on the information provided within this application

•For more information patients must call phone: 833KKCARES (8335522737), Hours: M–F, 8AM to 8PM ET

Enrollment Forms

Enrollment Form