Vyepti Connect Copay Assistance Program - Covered benefit
Coverage RequiredFunded
About
The Vyepti Connect Copay Assistance Program - Covered benefit offers significant financial support to patients prescribed Vyepti. This program enables eligible individuals to potentially pay as little as $0 per infusion of Vyepti, with a program assistance cap of $200 per infusion. By participating in the Vyepti Connect Copay Assistance Program, patients can manage their medical expenses more effectively, ensuring access to necessary treatments of Vyepti at a reduced cost.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•$2400 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: Yes
•Needs Based: No
•Activation Required: Yes
Program Details
•Eligible patients may pay as little as $0 per infusion
•Program assistance cap of $200 per infusion for eligible administration costs; calendar year maximum on all program assistance for all outofpocket expenses
•Must have a valid prescription for VYEPTI (up to 300 mg) for an approved indication at the time the prescription is filled by the pharmacist, or at the time the HCP administers VYEPTI to the patient
•HCP or office personnel will need to fax or email documentation, typically in the form of an Explanation of Benefits (EOB) after each dose.
•• The tollfree fax number is 8662183479; reimbursement will be sent after the EOB is reviewed and approved
•All documentation can also be mailed to: Attn: VYEPTI CONNECT Copay Assistance Program, 2250 Perimeter Park, Suite 300, Morrisville, NC 27560
•Patient enrollment will automatically renew each calendar year
•Call 8334893784, Monday through Friday, 8 AM 8 PM ET, for assistance or additional information
Enrollment Forms
Enrollment Form