X4Connect Copay Assistance Program: Xolremdi

Funded

About

The X4Connect Copay Assistance Program: Xolremdi offers outstanding benefits for patients needing Xolremdi, making healthcare more affordable by reducing out-of-pocket expenses for eligible participants. Patients prescribed Xolremdi can benefit from this program by potentially paying as little as $0, thereby easing the financial burden of medication costs.

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 commercially insured patients may pay as little as $0 outofpocket up to a maximum annual limit

•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