JazzCares Quick Start Voucher

Funded

About

The JazzCares Quick Start Voucher program offers an exceptional benefit for patients prescribed Xyrem or Xywav. This initiative is designed to assist those facing insurance coverage delays by providing a one-month free supply for eligible patients. Leveraging the JazzCares Quick Start Voucher can help ensure uninterrupted access to your prescribed medication with ease and confidence.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

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 be able to receive a voucher good for up to onemonth’s free supply (maximum of three bottles) for their firsttime shipment

•Patients must be experiencing an insurance coverage decision delay greater than 10 calendar days for XYWAV or XYREM or for patients changing from XYWAV or XYREM who are at risk of therapy interruption (i.e., less than seven calendar days from the patient’s next XYWAV or XYREM delivery date).

•There is a lifetime limit of one voucher per patient; the voucher may not be applied retroactively and does not cover refills

•For more information call 18335335299,MondayFriday, 8 AM8 PM ET

•Fax completed form to 18664701744

Enrollment Forms

Enrollment Form