Zydelig AccessConnect Patient Assistance Program

Funded

About

The Zydelig AccessConnect Patient Assistance Program offers essential support for patients in need of Zydelig, a critical medication. This program helps patients without prescription coverage for Zydelig by ensuring they receive their medication through a structured enrollment process. By meeting certain eligibility requirements, such as being a U.S. resident under the care of a physician, patients can access valuable assistance, including benefits investigation and a 'QuickStart' bridge program for those experiencing coverage delays.

Insurance requirements: Commercially insured, 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

•Patient must fax completed Zydelig Access Connect Patient Enrollment Form to: 18555538672, including insurance and prescriber information. Patient and prescriber signatures are required

•HCP can enroll patients in ZYDELIG AccessConnect, fax completed enrollment form to ZYDELIG AccessConnect at 18555538672

•'QuickStart' bridge program available to those experiencing coverage delays of greater than 5 business days; requests can be made on the same enrollment form

•A benefits investigation will take place and, upon approval, medication will either be shipped to the prescriber's office or to the patient

•Patients must not be Medicare or Medicaid eligible

•For more information patients must call 18446222377, MondayFriday 8am to 5pm ET

Enrollment Forms

Enrollment Form