Ztalmy One Prescription Support Programs

Funded

About

The Ztalmy One Prescription Support Programs provide essential assistance for patients needing Ztalmy. This program is especially beneficial for eligible uninsured and underinsured patients, offering support with prescription costs and facilitating access even when there's a gap or delay in coverage. By completing a straightforward enrollment process, both healthcare providers and patients can efficiently participate in the Ztalmy One Prescription Support Programs and reap its numerous benefits.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•For eligible uninsured and underinsured patients or patients with no insurance, limited insurance, a gap or delay in coverage may be able to receive help with the cost of their prescription

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

•Patient must have a valid prescription

•For questions, please call ZTALMY One at 18449825691 MondayFriday 8am8pm ET

Enrollment Forms

Enrollment Form