JazzCares Patient Assistance Program: Xyrem
Funded
About
The JazzCares Patient Assistance Program: Xyrem offers a valuable opportunity for patients to access the drug Xyrem at no cost. This program is designed for patients who face financial challenges, including those with limited or no prescription insurance coverage. By participating in the JazzCares Patient Assistance Program, eligible patients who meet the income and residence criteria can receive their medication free of charge, ensuring continuity of care and treatment efficacy.
Insurance requirements: Medicare / Medicaid, 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
•Program is available for those with additional financial needs
•Patients must meet certain financial criteria, such as having a low income level, are uninsured or underinsured, to be eligible to receive XYREM at no cost
•Patient may complete application online or download, print, complete, sign, date, and mail application to JazzCares Patient Assistance Program, PO Box 66589, St. Louis, MO, 631666589, or fax to 8664701744
•Patient may also complete the online application and upload copies of applicable documentation at https://jazzcares.com/patients/xyrem/
•For more information call 8669973688 MonFri, 7AM8PM CT
Enrollment Forms
Enrollment Form