Prialt Savings Program

Funded

About

The Prialt Savings Program offers significant financial support to eligible patients prescribed the drug Prialt. Designed for commercially insured patients, the Prialt Savings Program allows participants to pay as little as $20 per prescription, with a maximum annual benefit of $8000. This program provides an accessible way for patients to afford their needed medication while ensuring that enrollment is straightforward through the completion and faxing of a simple form.

Insurance requirements: Commercially insured

As low as: $20 per fill

Enrollment Forms

Enrollment Form

Benefits

•$8000 annual maximum benefit

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible commercially insured patients may pay as little as $20 per prescription

•Maximum benefit of $8000 per year

•HCP and patient must sign and complete enrollment form and fax to 18558363066

•Patients should call 18556868725 (MonFri 9:00 am to 6:00 pm ET) for further information

Enrollment Forms

Enrollment Form