Xenazine Copay Assistance Program

Funded

About

The Xenazine Copay Assistance Program provides financial support to help patients afford their Xenazine prescriptions. Designed for patients with insurance that covers Xenazine but do not fully reimburse the drug's cost, the program ensures that eligible participants can manage their copays effectively. Patients must meet specific eligibility criteria, including age and insurance requirements, to benefit from the Xenazine Copay Assistance Program.

Insurance requirements: Commercially insured

As low as: $10 per mo

Enrollment Forms

Enrollment Form

Benefits

•12 maximum fills per year

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

•For patients whose insurance policy provides coverage for Xenazine and who are not reimbursed for the entire cost of the prescription are eligible for the copay assistance

•Patients pay at least $10 for each 30day prescription

•Physician must fax completed "Treatment Form" to 18663415601 in order to refer patient to program

•Program then verifies benefits and enrolls patient in program immediately

•For pharmacy questions regarding claim transmission, call the LoyaltyScript program at 18006577613 (8:00 am8:00 pm ET, Monday through Friday)

•Acceptance of card and submission of claims are subject to the LoyaltyScript program: www.mckesson.com/mprstnc

Enrollment Forms

Enrollment Form