Apellis Patient Assistance Program: Syfovre

Funded

About

The Apellis Patient Assistance Program: Syfovre offers an incredible opportunity for eligible patients to access the drug Syfovre at no cost for up to one year. This beneficial program is designed to support patients who are either uninsured, underinsured, or unable to afford their co-pay for Syfovre. By providing Syfovre free of charge, the Apellis Patient Assistance Program: Syfovre ensures that patients who need this medication can receive it, provided they meet the financial and medical criteria outlined by the program.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•If approved, the patient may receive Syfovre for free in onemonth increments for up to one calendar year, after which reapplication is required

•To apply, patient must fill out section 4.1 of the enrollment form to determine if the patient meets the financial eligibility criteria

•Once enrollment form has had all sections filled out, fax to 8884056966

Enrollment Forms

Enrollment Form