Xermelo Patient Assistance Program
Funded
About
The Xermelo Patient Assistance Program offers vital support for patients in need of the drug Xermelo. This comprehensive program provides eligible patients with free medication for a year, ensuring that individuals requiring Xermelo can access it conveniently as it is shipped directly to their homes. The Xermelo Patient Assistance Program requires referral by a physician and completion of an enrollment form. With a focus on financial and insurance eligibility, the program caters to patients whose annual income is below 400% of the Federal Poverty Level, providing an invaluable resource for those needing Xermelo.
Insurance requirements: Medicare / Medicaid, Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Program Requirements
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: Yes
•Activation Required: No
Program Details
•Eligible patients qualify for free medication for 1 year
•Medication is shipped to patient's house
•Patient must be referred to program by physician
•Patient and prescriber should fill out enrollment form and fax to 18552155318
•Eligibility cannot be determined until all of the information submission requirements have been met by the healthcare professional, patient, and/or caregiver
•Patient financial information and insurance status are required to determine whether a patient qualifies for assistance
Enrollment Forms
Enrollment Form