Xembify Connexions Patient Assistance Program

Funded

About

The Xembify Connexions Patient Assistance Program offers significant benefits by providing Xembify at no cost for eligible patients without coverage. By participating in the Xembify Connexions Patient Assistance Program, patients can access necessary medication for on-label uses, ensuring vital healthcare needs are met with the support of the Xembify Connexions team.

Insurance requirements: Uninsured

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: Yes

•Activation Required: No

Program Details

•Patients with no coverage may be eligible to receive XEMBIFY at no cost through the Patient Assistance Program

•HCP and patient should fill out and complete the form, then return it via fax to 8773750758 or by mail to Xembify Connexions, PO Box 31137, Bethesda, MD 20824

•Call Xembify Connexions team at 8446993624, Monday through Friday 8 AM to 8 PM ET for more information

Enrollment Forms

Enrollment Form