Valchlor Co-pay Program

Funded

About

The Valchlor Co-pay Program offers significant financial relief for patients prescribed Valchlor. By participating in the Valchlor Co-pay Program, eligible patients can benefit from reduced out-of-pocket costs, potentially paying as little as $0 per prescription fill for Valchlor. This program is specifically designed to assist those with commercial or private insurance, ensuring that accessing Valchlor is as affordable as possible.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

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 commercially insured patients may pay $0 per prescription fill

•HCP and patient should complete form and fax back to 8772519475

•For assistance with any questions, call 8554825245, Monday through Friday from 8 am to 8 pm ET

Enrollment Forms

Enrollment Form