Provides you with access to RELiZORB if the coverage process is anticipated to take longer than expected. Through this program, you may receive bridge product while the insurance coverage process is underway. Once coverage is obtained, you'll be transitioned to a specialty pharmacy provider who will fill your subsequent orders.
The program is open to individuals who:
If You Qualify, Enrollment in the Program is Automatic
If you are eligible, you will be enrolled in the program when RELiZORB Support Services reviews your commercial insurance benefits. Enrollment in the program is subject to confirmation of eligibility.
How Much Could I Save?
The program requires the patient to pay a minimum of $25 or the full amount of their co-pay, co-insurance, or deductibles, whichever is less, for each 30-count box of RELiZORB.
There is no out-of-pocket assistance card required — your benefit will be automatically deducted from your bill.*
*The program provides a maximum $300 benefit for each 30-count pack.
Program Terms and Conditions
RELiZORB is available at no cost to patients experiencing financial difficulties through the RELiZORB Patient Assistance Program (PAP). Eligible patients typically have no healthcare coverage for the requested product and do not have access to alternative sources of coverage or funding. All applications are reviewed on a case-by-case basis to support the RELiZORB Patient Assistance Program’s purpose of providing products at no cost to individuals in need.
How to Enroll in the RELiZORB Patient Assistance Program
An enrollment form is available from RELiZORB Support Services by calling 1-844-632-9271. The following checklist should be used when completing the application.
Checklist for Submitting an Application:
Email or fax the completed documentation to RelizorbOrder@asembia.com or 1-844-233-3146