Copay support
May reduce eligible commercially insured patients' ZYMFENTRA medication cost to as little as $0, subject to current benefit limits.
What it does
Supports eligible ZYMFENTRA medication claims through Celltrion CARES review and a virtual benefit card. Current terms allow up to 14 uses per calendar year and retroactive claim review within 90 days.
Open official program pageAvailable to eligible adults with commercial insurance that provides some ZYMFENTRA coverage, an on-label prescription, and at least six months of US or Puerto Rico residence.
Government program exclusions: Medicare, Medicaid, TRICARE, VA, DoD, Other federal or state healthcare programs
Send the prescription to the dispensing pharmacy or designated e-prescription channel.
Provide current pharmacy and medical insurance details.
Complete authorization online or on the official enrollment form.
Submit claim and payment records to Celltrion CARES within 90 days when requesting retroactive support.
Enroll through Celltrion CONNECT or the clinic form. The clinic can also e-prescribe to Phyz. Once approved, the pharmacy uses the assigned virtual card or claims instructions.
Best for: Patients or caregivers who can complete the official web form
Enter the requested patient, prescription, contact, and insurance information; select the services requested.
Patient, Celltrion CONNECT, Celltrion CARES, Specialty Pharmacy
Celltrion CONNECT
Enrollment, savings, benefits, authorization, temporary access, Nurse Connector, and patient assistance.
Monday-Friday, 8 AM-8 PM ET
Official current copay terms.
Comprehensive official support page with current temporary-access rules.
Owner: Patient or caregiver
Have ready: Age, ZYMFENTRA prescription, Residence, Commercial insurance, Contact information, Consent
Review the authorization and program terms, provide consent, and submit the form.
Owner: Patient or caregiver
Best for: Services requiring clinical information, a prescription, or prescriber attestation
Patient completes demographics and the authorization/consent section of the official form.
Owner: Patient
Have ready: Contact information, Signature and date
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Completed patient authorization, Insurance cards, Prescription and prescriber signature
Submit the completed form by fax to 1-833-912-3707.
Owner: Clinic staff
After enrollment: Give the approved copay information to the specialty pharmacy. Use Celltrion CARES for any supported retroactive claim request within 90 days.
If there is a problem: Call Celltrion CONNECT if the pharmacy cannot apply the virtual card or if a retroactive claim is approaching the 90-day deadline.
Official combined enrollment form with three submission paths.
