Utibron Patient Assistance Programs

Utibron: Apply for prescription assistance below

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

Sunovion Support Prescription Assistance Program (Arcapta, Seebri & Utibron Neohaler)

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

Provided by: Sunovion Pharmaceuticals, Inc.
PO Box 220285 Charlotte, NC 28222-0285
TEL: 877-850-0819
FAX: 877-850-0821
Languages Spoken:
English
Program Website
Medications
  • Utibron neohaler (indacaterol/glycopyrrolate neohaler)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage
  • Those with Part D Elibible? No
  • Income At or below 300% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from 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 Within a week
Medication
  • Amount/Supply Up to 30 day supply
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Varies
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit Maximum of 11 refills in one year
  • Re-application New application yearly
Additional Information
None
Updated May 1, 2018

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

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