X4Connect Bridge Program: Xolremdi
Funded
About
The X4Connect Bridge Program: Xolremdi offers crucial support for patients prescribed Xolremdi who are experiencing a temporary interruption in insurance coverage. This program ensures that eligible patients can maintain access to their necessary medication during times of insurance uncertainty, highlighting the commitment of the X4Connect Bridge Program: Xolremdi to patient care and support.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible patients who are facing an interruption in insurance coverage may be able to receive a free temporary supply of medication
•HCP should fax completed enrollment form and any applicable documentation to 8779140598
•For assistance or additional information, call 8449426628, MF, 8am8pm ET
Enrollment Forms
Enrollment Form