Rebyota Co-pay Program

Funded

About

The Rebyota Co-pay Program is designed to offer significant financial assistance for patients prescribed Rebyota for an FDA-approved indication. This program helps commercially insured patients pay as little as $100 per prescription with coverage benefits up to $10,000 annually. Rebyota Co-pay Program is an excellent support initiative for ensuring access to this essential treatment while managing out-of-pocket expenses.

Insurance requirements: Commercially insured

As low as: $100 per fill

Enrollment Forms

Enrollment Form

Benefits

•$10000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Commercially insured patients may pay as little as $100 for each prescription

•Provide coverage maximum cap of up to $5,000 per dose with a maximum benefit of $10,000 per patient per calendar year

•HCP and patient must complete form and fax to 18777787167

•Program does not cover the cost of administration, office visits, or any associated costs

•For assistance call: 1877REBYOTA, MondayFriday 8 a.m. – 8 p.m. EST

Enrollment Forms

Enrollment Form