JazzCares Patient Assistance Program: Xywav

Funded

About

The JazzCares Patient Assistance Program: Xywav provides essential support for individuals needing the medication Xywav, ensuring access to those who meet specific eligibility criteria. The program is designed to assist patients in the United States, Puerto Rico, or a U.S. Territory with limited or no prescription insurance coverage, offering financial relief for those with additional financial needs. With JazzCares, qualified patients can receive Xywav at no cost, facilitating crucial treatment for those who are uninsured or underinsured.

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 XYWAV 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/xywav/

•For more information call 8669973688 MonFri, 7AM8PM CT

Enrollment Forms

Enrollment Form