Orilissa Patient 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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AbbVie Patient Assistance Program Foundation 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:
Program Website
  • Orilissa (elagolix)
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? The patient must also be residing in the US.
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from Programs website
  • Returning The completed application can be faxed or mailed back.
  • 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 3-5 business days
  • Amount/Supply Varies
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Within 3-5 business days
  • Refill Proces Patient must contact company
  • Limit One year
  • Re-application Company contacts patient about reapplying
Additional Information
Updated September 25, 2018

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