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Introducing ZYFLO connect®*
This program offers your patients a $0 co-pay (or up to $2,500 per month) on ZYFLO CR® (zileuton), shipping direct to their door, and other free features, plus streamlined enrollment and prior authorization.
Benefits for your patients
$0 monthly co-pay* on every prescription so patients pay nothing out-of-pocket
Free, next-day delivery direct to your patient’s door
Refill reminder phone calls from a ZYFLO connect® pharmacist
Pharmacists available by phone 24/7 for questions
Simple and streamlined enrollment process
Get prior authorization support by phone from ZYFLO connect® representatives to help with reimbursement approval
Get your patients started with ZYFLO connect® today
If you are uninsured or have commercial insurance, including insurance purchased through the Affordable Care Act Exchange plans, Chiesi USA may help pay the out-of-pocket expenses (co-pay, co-insurance, deductibles) of your prescription. For patients taking ZYFLO CR® (zileuton) extended-release tablets or ZYFLO® (zileuton) tablets (collectively, "ZYFLO"), up to $2,500 per month will be provided, if you meet the eligibility requirements below. If the total costs of your out-of-pocket expenses are over $2,500 per month, you will be responsible for the outstanding balance.
You are either:
You are insured by commercial or private insurance and your insurance does not cover the full cost of ZYFLO or ZYFLO CR
Your prescriptions are not covered in full or in part by any state or federally funded insurance program, including but not limited to Medicare, Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”); patients who move from commercial to state or federally funded prescription insurance will no longer be eligible
You are at least 18 years of age
Void where prohibited by law
Out-of-pocket benefit equals an amount up to $2,500 per month (maximum benefit of $30,000 per year) for ZYFLO or ZYFLO CR. Patient is responsible for applicable taxes, if any.
EXAMPLE: If your monthly ZYFLO or ZYFLO CR prescription co-pay or out-of-pocket cost is $3,000, eligible patients will only pay $500 per month for ZYFLO or ZYFLO CR, a savings of $2,500 off of their co-pay or total out-of-pocket costs. If your co-pay or out-of-pocket costs are no more than $2,500, you pay $0. For a mail-order 3-month prescription, your total maximum savings will be $7,500 ($2,500 x 3).
If a patient exceeds the maximum monthly benefit of $2,500, the patient will be responsible for the outstanding balance.
Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party, for any part of the benefit received by the patient through this offer.
Your acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value received as may be required by your insurance provider.
Only valid in the United States or Puerto Rico; this offer is void where restricted or prohibited by law.
No membership fees.
The ZYFLO Connect program is not insurance.
The ZYFLO Connect program cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
The ZYFLO Connect program expires on December 31, 2016.
The ZYFLO Connect program is limited to one per person.
Chiesi USA reserves the right to rescind, revoke, or amend this offer at any time without notice.
The ZYFLO Connect program is only offered through distribution from Foundation Care, a full-service pharmacy serving patients in all 50 states and Puerto Rico.
Foundation Care, 4010 Wedgeway Court, Earth City, MO 63045 Phone: (844) 699-9356
ZYFLO CR (zileuton) is indicated for the prophylaxis and chronic treatment of asthma in adults and children 12 years of age and older. ZYFLO CR is not indicated for use in the reversal of bronchospasm in acute asthma attacks. Therapy with ZYFLO CR can be continued during acute exacerbations of asthma.
Important Safety Information
ZYFLO CR is contraindicated in patients with active liver disease or persistent hepatic function enzyme elevations ≥3 times the upper limit of normal or a history of allergic reactions to zileuton or any of the other ingredients.
Elevations of one or more hepatic function enzymes and bilirubin may occur during ZYFLO CR therapy.
Assess hepatic function enzymes prior to initiation of ZYFLO CR, monthly for the first 3 months, every 2-3 months for the remainder of the first year, and periodically thereafter.
If clinical signs and/or symptoms of liver dysfunction develop (e.g., right upper quadrant pain, nausea, fatigue, lethargy, pruritus, jaundice, or “flu-like” symptoms) or transaminase elevations ≥5xULN occur, discontinue ZYFLO CR and follow hepatic function enzymes until normal.
Neuropsychiatric events, including sleeping disorders and behavioral changes, may occur with ZYFLO CR.
The active ingredient in ZYFLO CR increases theophylline, warfarin, and propranolol levels. Dose adjustment of these other drugs and patient monitoring may be required.
ZYFLO CR should be used with caution in patients who consume substantial quantities of alcohol and/or have a history of liver disease.
In a long-term clinical trial (n=926), the incidence of ALT elevations (≥3xULN) was 1.8% in the ZYFLO CR group, compared to 0.7% in the placebo group.
Most common adverse reactions (≥5%) included: sinusitis, nausea, and pharyngolaryngeal pain.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.