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†
- Eligible commercially insured patients 18 years or older could pay as little as $0/month with a maximum savings up to $5,500 monthly and a maximum annual program benefit of $25,000.
†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?
GILOTRIF Patient Support Kits
- Approved Dispensing Pharmacies can place an order for a GILOTRIF Patient Support Kit (PC-US-102908) for patients and providers by e-mailing email@example.com (maximum 3 kits per month)
Boehringer Ingelheim cares foundation patient assistance program
For: Eligible patients who are uninsured or underinsured
The BI Cares Patient Assistance Program is a charitable program provided by the Boehringer Ingelheim Cares Foundation, an independent nonprofit organization. The program helps those in need obtain Boehringer Ingelheim medications including Gilotrif free of charge. Patients prescribed Gilotrif who apply must meet program eligibility requirements including income and prescription coverage criteria in order to be enrolled. The program requires a completed application form signed by patient and healthcare provider and supporting documentation.
Visit the BI Cares Website