Zynlonta Copay Program
Funded
About
The Zynlonta Copay Program provides significant financial benefits for eligible patients prescribed Zynlonta. Through the Zynlonta Copay Program, patients can lower their out-of-pocket expenses to as little as $0 per dose, with an annual maximum benefit of $25,000. The program supports patients who have commercial or private insurance and are prescribed Zynlonta for an FDA-approved indication.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•$25000 annual maximum benefit
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Must be 18 years of age or older
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible patients may pay as little as $0 per dose
•Program has a maximum benefit of $25,000 per patient, per calendar year (January 1 through December 31)
•Must have a valid prescription for ZYNLONTA™ for an FDAapproved indication
•HCP can enroll patients online, by completing and faxing an enrollment form to 18559153005, or by emailing the completed form to support@ADVANCINGPatientSupport.com
•Enrollment form can be downloaded from here: https://www.advancingpatientsupport.com/wpcontent/uploads/2022/03/UpdatedZYNLONTAAPSEnrollmentFormUSCommLTX0005947.pdf
•If enrolling a patient online, patient must fill out and submit a Patient Authorization form
•If acquiring ZYNLONTA™ from a Specialty Pharmacy (to be later administered in a physician office or outpatient institution), additional documentation may be required
•For more information call 18556900340, MondayFriday, 8AM8PM ET
Enrollment Forms
Enrollment Form
Other Programs
ADVANCING Patient Support Patient Assistance Program: Zynlonta
Underinsured
Uninsured
HealthWell: B-Cell Lymphoma - Medicare Access
Medicare / Medicaid
Max Saving: $8000/year*