Quzyttir Patient Assistance Program

Funded

About

The Quzyttir Patient Assistance Program offers invaluable support for patients in need of Quzyttir medication. Designed specifically to aid those with financial need, the Quzyttir Patient Assistance Program ensures patients can access up to six doses per shipment, pending eligibility. With an easy enrollment process facilitated through fax, healthcare providers can swiftly initiate patient participation. For detailed guidance and benefits, the Quzyttir Patient Assistance Program encourages direct contact via their support number.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•HCP can fax completed enrollment form (with patient signature) for benefits investigation and PAP enrollment

•Enrollment form should be faxed to 18558363066

•Eligible patients will receive a maximum 6 doses of Quzyttir per shipment will be sent to the prescriber or other facility as specified

•Additional PAP shipments allowed, pending continued patient eligibility

•For more information patients must call 18556868725 Monday Friday (8 AM to 8 PM ET)

Enrollment Forms

Enrollment Form