X4Connect Patient Assistance Program: Xolremdi
Funded
About
The X4Connect Patient Assistance Program: Xolremdi provides a valuable opportunity for eligible patients to receive the drug Xolremdi free of charge. This program is designed to help patients who have limited or no prescription insurance coverage, ensuring they have access to necessary medication. Through X4Connect, patients with a valid prescription for Xolremdi, who meet specific income guidelines and are being treated for an FDA-approved indication, can benefit significantly from this supportive program.
Insurance requirements: Underinsured, Uninsured
Enrollment Forms
Enrollment Form
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: Yes
•Activation Required: No
Program Details
•Eligible patients may be able to receive medication free of charge
•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