Zydelig AccessConnect QuickStart Program

Funded

About

The Zydelig AccessConnect QuickStart Program offers a valuable solution for eligible patients prescribed Zydelig. Designed to address delays in insurance coverage, the program provides a complimentary 30-day supply of Zydelig 150 mg tablets. The Zydelig AccessConnect QuickStart Program ensures patients can start their treatment without interruption by offering a free bottle for those with coverage delays exceeding five business days. With a focus on quick access, patients must be enrolled in the Zydelig AccessConnect Program and have an on-label prescription for Zydelig to qualify.

Insurance requirements: Commercially insured, Medicare / Medicaid, Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Benefits

•1 maximum fills per year

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Eligible patients experiencing an insurance coverage delay greater than 5 business days may be eligible for a free 30day supply

•Program provides eligible patients with 1 free bottle that includes a 30day supply of ZYDELIG 150 mg tablets

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

•A minimum 5businessday insurance verification period is required for patients to be eligible for the QuickStart Program

•Patients must have an onlabel prescription for ZYDELIG, consistent with the FDAapproved label for ZYDELIG, and be enrolled in the ZYDELIG AccessConnect Program to qualify

•Free product for the QuickStart Program will only be available through the QuickStart Specialty Pharmacy

•An extension period beyond the initial 30day supply is limited to commercially insured patients and individual approval is required

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

Enrollment Forms

Enrollment Form