Tagrisso Co-pay Savings Program

Funded

About

The Tagrisso Co-pay Savings Program provides significant financial relief for patients prescribed Tagrisso. By covering out-of-pocket costs for the medication, up to $26,000 per year, and allowing patients to pay only $0 per 28-day supply, the Tagrisso Co-pay Savings Program ensures that patients with commercial insurance can access their medication affordably. With no income details or restrictions for certain states, the Tagrisso Co-pay Savings Program is dedicated to helping patients in the United States and Puerto Rico maintain their health without financial burden.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

Benefits

•$26000 annual maximum benefit

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

•Patient pays $0 per 28day supply, program pays the remaining outofpocket costs up to a maximum of $26,000 per year

•Must have valid prescriptions

•The TAGRISSO Patient Savings Program covers the cost of the drug and administration, but does not cover costs for office visits or any other associated costs

•Patients may be contacted by a pharmacy or HCP with outofpocket cost; eligible patients can ask to be enrolled in the program or can enroll by contacting Access 360 at 18442752360

•Patient and HCP must complete form, sign and fax all pages to 18443292360

•HCP or Pharmacy may also enroll patients online at: https://www.myaccess360providerportal.com/

•Offer is invalid for claims or transactions more than 365 days from the date of service

•For questions or assistance, please call Access 360, Monday through Friday, 8am8pm at 18442752360

Enrollment Forms

Enrollment Form