Ztalmy One Copay Savings Program

Funded

About

The Ztalmy One Copay Savings Program offers an incredible opportunity for patients prescribed Ztalmy to significantly reduce their prescription costs. With this program, eligible patients can pay as little as $0 per prescription, provided they have commercial insurance and meet other criteria. The Ztalmy One Copay Savings Program is an invaluable resource for U.S. residents, streamlining the process to make Ztalmy more accessible and affordable.

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 may pay as low as $0 per prescription; maximum 30day supply per fill

•Maximum assistance information can be accessed by calling ZTALMY One at 18449825691

•HCP and patient must complete enrollment form, send copies of insurance card and benefit cards (front and back) then fax to 8449825693

•Offer is limited to one per person

•Patient must have a valid prescription

•For questions, please call ZTALMY One at 1‑844‑982‑5691 MondayFriday 8am8pm ET

Enrollment Forms

Enrollment Form