Ask your doctor if ZYFLO CR® is right for you.
Once you're enrolled, a ZYFLO connect® representative will give you a welcome phone call and automatically apply the co-pay assistance to your initial shipment. They will also confirm your delivery location preference and go over the refill reminder options with you.
Download a PDF of the ZYFLO CR® (zileuton) patient brochure
*ZYFLO Connect Terms and Conditions
How It Works
- 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:
- Uninsured, or
- 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