Follow these simple steps to enroll your patients
Mail: The ZILRETTA Copay Assistance Program
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560
Eligible patients will receive a letter or fax informing them that they can receive up to a $100 rebate on their ZILRETTA injection. To receive the rebate, patients will need to send a copy of their EOB or itemized Specialty Pharmacy receipt for ZILRETTA along with the completed application form. Your office will be notified by mail or fax when your patient is approved for the rebate.
Patients may be eligible if they:
- Have private insurance plan that covers the medication costs of ZILRETTA
- Are not covered by any federal- or state-funded healthcare programs, such as Medicare, Medicaid, or TRICARE
- Live in the United States, Puerto Rico, or United States Territories
Please note that this rebate only covers out-of-pocket copay or coinsurance costs for ZILRETTA and does not cover administrative costs, office visit costs, or deductibles.
To learn more about the ZILRETTA Copay Assistance Program, call 1-844-248-7732.
The ZILRETTA Copay Assistance Program Terms and Conditions
Patient must have commercial health insurance that covers the medication costs of ZILRETTA. Patients are not eligible if prescriptions are paid, in whole or in part, by federal- or state-subsidized healthcare program that covers the cost of ZILRETTA, including Medicare, such as Medicare Part D prescription drug beneﬁt, Medicaid, TRICARE, a qualiﬁed health plan (QHP), Federal Employee Program (FEP), or any other federal or state healthcare plan, including pharmaceutical assistance programs, or where prohibited by law. The ZILRETTA Copay Assistance Program covers ONLY the out-of-pocket cost of ZILRETTA, up to an annual maximum dollar limit. The ZILRETTA Copay Assistance Program does not cover administrative or ofﬁce visit costs. Cash patients are not eligible for this offer. Patient is responsible for reporting receipt of copay assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription ﬁlled, as may be required. The ZILRETTA Copay Assistance Program is available for patients residing in the US, Puerto Rico, or US Territories. Flexion Therapeutics reserves the right at any time and for any reason, without notice, to modify or discontinue any service or assistance provided through the Copay Assistance Program.
* Based on FlexForward’s database of 6,075 commercially covered patients from October 2020 to March 2021, 93% of patients had out-of-pocket drug-related costs of <$150 (~65% paying <$100 and ~28% paying $100-<$150), with the ZILRETTA Copay Assistance Program reimbursing up to $100 for eligible patients.1
† 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.