Vyxeos Copay Program

Funded

About

The Vyxeos Copay Program offers substantial financial benefits to patients by allowing them to pay as little as $10 per prescription of the drug Vyxeos, subject to an annual maximum. This program is designed to support patients who have private insurance coverage, providing a streamlined process for enrollment and payment assistance. The Vyxeos Copay Program underscores its commitment to affordability and accessibility for eligible patients through its user-friendly processes and supportive resources.

Insurance requirements: Commercially insured

As low as: $10 per fill

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

•Patients may pay as little as $10 per prescription, subject to an annual maximum

•HCP and patient must complete form and fax to 18555933955 or mail to JazzCares Program, PO Box 5490, Louisville, KY 40255 or complete the enrollment electronically through jazzcares.com/hcp/vyxeos

•Must provide copy of the front and back of patients insurance card

•Must sign and date Patient Authorization form or may complete the authorization electronically through jazzcares.com/vyxeos

•For more information, please call JazzCares toll free at 18335335299, MondayFriday, 8 am to 8 pm ET

Enrollment Forms

Enrollment Form