This product qualifies for the ZELNORM Patient Assistance program. This private and confidential program provides product free of charge to eligible individuals, primarily the uninsured who, without our assistance, could not afford ZELNORM. Individuals who don’t meet the insurance criteria may still qualify for this program if they attest that they have special circumstances of financial and medical hardship, and their income meets the program criteria. A single application for assistance may provide for up to 6 months of product free of charge to eligible individuals and an individual may reapply every 6 months and as many times as needed. If you have been prescribed ZELNORM, you may be eligible for the program if a combination of the following conditions apply:
- You are a US or Puerto Rico resident and have a prescription for ZELNORM from a health care provider licensed in the United States or Puerto Rico.
- You do not have insurance or other coverage for your prescription medicine. Some examples of other insurance coverage include private insurance, HMOs, Medicaid, Medicare, state pharmacy assistance programs, veterans assistance, or any other social service agency support. You cannot afford to pay for your medicine. You may qualify for the program if you have a household income that meets the income levels outlined for this program.
At Alfasigma USA we realize that sometimes exceptions need to be made based on the patient’s individual circumstances. If you do not meet the prescription drug coverage criteria, your income meets the program criteria, and there are special circumstances of financial and medical hardship that apply to your situation, you can request that an exception be made for you.