Zilretta Patient Assistance Programs

Zilretta: Apply for prescription assistance below

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

FlexForward Comprehensive Access Support

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

Provided by: Flexion Therapeutics, Inc.
None
TEL: 844-353-9466
FAX: 866-558-7939
Languages Spoken:
English
Program Website
Program Applications and Forms
Medications
  • Zilretta (triamcinolone acetonide)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
  • U.S. Residency Required? The patient must also be residing in the US.
Application
  • Obtaining Call or download
  • Receiving Faxed or downloaded from website
  • Returning The completed application must be faxed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Inform Doctor that he/she is in need
  • Decision Communicated Doctor notified
  • Decision Timeframe Not specified
Medication
  • Amount/Supply 1 kit
  • Sent To Doctor's office or specific site
  • Delivery Time 1-2 business days
  • Refill Proces One time program, no refills
  • Limit Not specified
  • Re-application This is a one time program
Additional Information
This program is intended for US HEALTHCARE PROFESSIONALS and/or Professionals involved in Healthcare Reimbursement ONLY.
Updated October 9, 2018

Back to top