Starting your Patient
Starting your Patients: A Step by Step Guide
GILOTRIF Patient Services–Brought you by Accredo®
Prescribing GILOTRIF for Non-dispensing Accounts
- Get a GILOTRIF prescription form*
Download Enrollment Form
Or, contact Accredo® at 1-844-569-2836, or contact your sales consultant
- Complete and fax the form to Accredo® at 1-888-454-8488
- Once GILOTRIF prescription enrollment is complete, your patients will receive a welcome call, confirming enrollment and insurance benefits.
The first delivery often arrives within 4 days. Upon receiving the prescription and enrollment form, Accredo® will fill the prescription and call your patients to schedule their GILOTRIF delivery.
*Some states may require a separate prescription.
Highlights within GILOTRIF Patient Services include:
Co-pay Assistance Program†
- Maximum out-of-pocket cost could be as little as $0 per month (subject to a maximum monthly benefit of $5,500 and a maximum annual program benefit of $25,000) for commercially insured US-resident patients
- No income eligibility or additional paperwork required
†Co-pay Assistance Program is only available to commercially insured patients.
- Eligible patients experiencing more than a 5-day payer approval delay can receive a 15-day supply of GILOTRIF at no cost to the patient for the FDA-approved indications
GILOTRIF Dose Exchange™
- Facilitates transition to a new dose at no cost to your patients§
- Eliminates additional GILOTRIF co-pay in a given month for eligible patients
- Eligible patients receive a new dose of GILOTRIF
- Convenient packaging to return unused tablets
- Call 1-844-569-2836 to learn more
Your Patient’s Roadmap once enrolled:
Non-dispensing Accounts Guide
For Your Patients: GILOTRIF My Guide
Are you from a Dispensing Account? See the resources below
Dispensing Pharmacies Guide
Solutions Plus® Enrollment Form
Dispensing Pharmacy Dose Exchange Form