Ingrezza Patient Assistance Programs

Ingrezza: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Ingrezza. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

HealthWell Foundation Copay Program

(Program 1 of 2 — Scroll down to see them all )

Provided by: HealthWell Foundation
PO Box 220410 Chantilly, VA 20153-0410
TEL: 800-675-8416
FAX: 800-282-7692
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Ingrezza (valbenazine)
Eligibility Requirements
  • Insurance Status May have insurance
  • Those with Part D Elibible? Yes
  • Income Varies
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or complete online
  • Receiving Sent out or may be completed online
  • Returning The completed application must be mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient notified in writing
  • Decision Timeframe 3-5 business days
Medication
  • Amount/Supply Not applicable
  • Sent To Varies
  • Delivery Time Not specified
  • Refill Proces Good for one year
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change.
Updated November 1, 2018

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Inbrace Support Program

(Program 2 of 2 — Scroll down to see them all )

Provided by: Neurocrine Biosciences, Inc.
1330 Enclave Parkway Suite 125 Houston, TX 77077
TEL: 844-647-3992
FAX: 844-394-7155
Languages Spoken:
English
Program Website
Medications
  • Ingrezza (valbenazine)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Determined case by case
  • Income Not disclosed
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must reside in the US, Guam, Puerto Rico or US Virgin Islands
Application
  • Obtaining Doctor/Doctor's office must call or download
  • Receiving Faxed to Doctor's office
  • Returning The completed application should be faxed back from the doctor's office.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply Varies
  • Sent To Doctor's office or patient's home
  • Delivery Time 1-2 business days
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application every 12 months
Additional Information
Resources for HEALTHCARE PROFESSIONALS ONLY. **Physicians apply for this program on behalf of their patients.
Updated September 17, 2018

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