Tavalisse Copay Assistance

Funded

About

Tavalisse Copay Assistance offers a beneficial program for patients prescribed Tavalisse, enabling eligible individuals to access their medication with a low copay of $15 per prescription when paying through commercial insurance. This program provides an annual cap on out-of-pocket expenses and requires annual re-enrollment, ensuring ongoing support for patients under the Tavalisse Copay Assistance initiative.

Insurance requirements: Commercially insured

As low as: $15 per fill

Enrollment Forms

Enrollment Form

Benefits

•$25000 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

•Eligible patients may receive TAVALISSE at a $15 copay for each prescription, if they pay through commercial insurance

•The patient will be responsible for any outofpocket expenses after the $25,000 annual cap

•Card can be printed for immediate use following online eligibility and enrollment

•Patient must reenroll annually

•No lifetime limitations on the number of fills redeemed by the patient

•Refills are permitted up to a maximum of 30 days of therapy

•Pharmacies can call the SimpleSaveRx Help Desk at 18447283479 for processing questions

Enrollment Forms

Enrollment Form