HELP YOUR PATIENTS PAY AS LITTLE AS $0 FOR EACH ZILRETTA INJECTION*

The ZILRETTA Co-Pay Program helps commercially insured patients access treatment for little to no cost and simplifies the enrollment process for you and your office.

KEY BENEFITS
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Reduced out-of-pocket costs: Eligible patients may pay as little as $0 for ZILRETTA, with an annual cap of $1,000.

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Hassle-free enrollment with FlexForward: Once you submit a benefits investigation (BI) request, FlexForward completes the BI and automatically enrolls the patient into the Program, if eligible.

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Quick claim processing and reimbursement: You can expect to receive reimbursement on approved claims within 1-2 weeks.

To see if your patients qualify for the ZILRETTA Co-Pay Program, visit FlexForward.com

Co-Pay Eligibility

Patients may be eligible if they:

  • Have a private insurance plan that covers the medication costs of ZILRETTA
  • Are not covered by any federally or state-funded healthcare programs, such as Medicare, Medicare Advantage, Medicaid, or TRICARE
  • Have a remaining cost share (i.e., deductible, co-insurance, or co-pay) after their primary insurance adjudicates
SIMPLE STEPS TO ENROLL PATIENTS
  • Once you decide to treat a patient with ZILRETTA, submit a BI request to FlexForward through the Portal or by fax:

    To submit a request by fax, complete the FlexForward Enrollment Form

  • FlexForward completes the BI and identifies the commercial patient’s remaining cost share

  • If eligible, FlexForward automatically enrolls your patient into the program

Eligible patients will receive a letter informing them of their automatic enrollment and that they may pay as little as $0 for ZILRETTA.§ When your patient is approved, your office will be notified by fax with directions on how to file a co-pay claim.

When acquiring ZILRETTA through Specialty Pharmacy, be sure to indicate “Auto Transfer to Specialty Pharmacy” within the enrollment process.

CONTACT INFORMATION

*This Program is not available to individuals enrolled in federal or state-subsidized healthcare programs that cover prescription drugs, including Medicare, such as Medicare Part D prescription drug benefit, Medicaid, Medicare Advantage, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs. Patient must be 18 years of age or older, a US citizen or permanent resident, and have an on-label diagnosis for ZILRETTA.

Reimbursement covers only out-of-pocket deductibles, co-pay, or co-insurance costs for ZILRETTA and does not apply to administrative or office costs.

FlexForward will triage patient enrollment details to dispensing Specialty Pharmacy if acquired via Specialty Pharmacy.

§This Program has an annual co-pay reimbursement cap of $1,000 for eligible patients.