X4Connect Quick Start Program: Xolremdi

Funded

About

The X4Connect Quick Start Program: Xolremdi is designed to provide eligible patients with timely access to their Xolremdi medication. This program offers a special solution for new patients experiencing delays in insurance coverage, ensuring they receive a free temporary supply of Xolremdi. The X4Connect Quick Start Program: Xolremdi supports those prescribed for an FDA-approved indication and helps them get their treatment without unnecessary interruptions. With a dedicated support line, the X4Connect Quick Start Program: Xolremdi is committed to facilitating access and continuous care for patients.

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 new to Xolremdi who are facing a delay 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