Yutiq Copay Program

Funded

About

The Yutiq Copay Program offers significant financial advantages for eligible patients prescribed Yutiq. With minimal out-of-pocket expenses for commercially insured patients, the Yutiq Copay Program ensures that the cost of treatment is manageable. The program does not impose income eligibility requirements, making it accessible to a broader patient population while providing up to $4,500 in assistance per eye.

Insurance requirements: Commercially insured

As low as: $25 per fill

Enrollment Forms

Enrollment Form

Benefits

•$9000 annual maximum benefit

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 with commercial or private insurance that covers YUTIQ for the approved indication may be able to pay as little as the first $25 of the copay for YUTIQ

•Patient will be responsible for the first $25 of the copay for YUTIQ. The program does not have an income eligibility requirement and there is a maximum assistance level of $4,500 per eye

•Program does not include assistance for patient cost share for injection procedure or other costs associated with the administration of YUTIQ.

•Household income and number in household is required information for program approval

•No income requirement, but household income and number in household is required information for program approval

•Completed enrollment form should be faxed to: 18667833124

Enrollment Forms

Enrollment Form