Orilissa Prescription Assistance Programs

Orilissa: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Orilissa. 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.

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myAbbVie Assist for Orilissa

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

Provided by: AbbVie
PO Box 66570 St. Louis, MO 63166
TEL: 866-244-9711
FAX: 866-750-6694
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Program Applications and Forms
  • Orilissa tablet (elagolix tablet)
Eligibility Requirements
  • Insurance Status Must be uninsured or underinsured
  • Those with Part D Elibible? Varies
  • Income At or below 400% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? Must reside in the US and be under the direct care of a US physician
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed or mailed 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 Varies
  • Amount/Supply As prescribed by Doctor
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Varies
  • Refill Proces Patient or Doctor must contact company
  • Limit Varies
  • Re-application Varies
Additional Information
Any patient who requires the medication and are in need should call the company. Eligibility determined on a case-by-case basis. Patients with prescription drug coverage may be eligible on exception basis. Contact program for details.
Updated September 3, 2019

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

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