Kyleena Patient Assistance Programs

Kyleena: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Kyleena. 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 or go to the program website.

Looking for a different medication?

ARCH Patient Assistance Program for Skyla, Mirena, and Kyleena

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

Provided by: Bayer HealthCare Pharmaceuticals Inc.
PO Box 5670 Louisville, KY 40255
TEL: 877-393-9071
FAX: 877-229-1421
Languages Spoken:
Program Website
  • Kyleena intrauterine system (levonorgestrel intrauterine system)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Not specified
  • Income Based on FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe 5-7 business days
  • Amount/Supply Amount requested is sent
  • Sent To Doctor's office
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit None
  • Re-application Not specified
Additional Information
Updated July 16, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Kyleena prices here.

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