Rayaldee Patient Assistance Program
Funded
About
The Rayaldee Patient Assistance Program offers a remarkable opportunity for U.S. citizens or legal residents in need of Rayaldee, by providing the drug at no cost. Designed for uninsured or functionally uninsured patients with financial distress, the program ensures access to necessary medication through a straightforward application process. The Rayaldee Patient Assistance Program emphasizes accessibility and support, helping patients manage their healthcare needs effectively.
Insurance requirements: Underinsured, 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
•Program designed to provide Rayaldee at no cost to patients who are uninsured or functionally uninsured and are financially distressed
•Patient's HCP must download and complete the Rayaldee Service Request Form (SRF) and fax to: 8446607083 or email to: opkoconnect@rxallcare.com
•Upon receipt of the SRF, a Rayaldee Support Specialist will contact the patient to obtain a completed PAP Application and the necessary supporting financial documentation
•Once an eligibility determination has been made, both the patient and the health care provider’s office will be informed of the patient’s ability to participate in the program
•This program can be modified or terminated at any time without notice by OPKO Renal, a division of OPKO Health, Inc
•The Rayaldee OPKO Connect Service Request Form (SRF) must be submitted prior to submitting the Rayaldee Patient Assistance Program Application (PAP)
•SRF: https://rayaldee.com/wpcontent/themes/rayaldee/pdfs/hcp/rayaldeeservicerequestform.pdf
Enrollment Forms
Enrollment Form