JazzCares Copay Program: Rylaze
Funded
About
The JazzCares Copay Program: Rylaze offers significant financial relief for eligible patients with its Rylaze drug product. This program is designed to help commercially insured patients reduce their copay costs to as little as $10 per prescription, making treatment more accessible. The JazzCares Copay Program: Rylaze is committed to supporting patients by providing easy enrollment online or through fax/mail, and personalized assistance via its helpline, ensuring a seamless experience in accessing Rylaze.
Insurance requirements: Commercially insured
As low as: $10 per fill
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible commercially insured patients may pay as little as $10 per prescription, subject to an annual maximum (must call for annual maximum details)
•HCP can enroll patients online or by completing an enrollment form and fax to 18555933955 or mail to JazzCares Program, PO Box 5490, Louisville, KY 40255
•Patient may sign and date the Patient Authorization Form (see last page of enrollment form) or may complete the authorization electronically through jazzcares.com/rylaze
•For more information call 18335335299, MondayFriday, 8AM8PM ET
Enrollment Forms
Enrollment Form
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