Temporary access
May provide ZYMFENTRA at no cost to eligible commercially insured patients after a seven-day coverage delay or a denial, for up to three years while coverage is pursued.
What it does
Supplies temporary product after the stated coverage event while the prescriber and clinic continue plan-required authorization or appeal work. Support ends when coverage is obtained or program limits are reached.
Open official program pagePotentially available to eligible commercially insured patients whose ZYMFENTRA coverage remains delayed for seven days or is denied, subject to current START criteria.
Government program exclusions: Medicare, Medicaid, TRICARE, VA, DoD, Other federal or state healthcare programs
Submit authorization, prescription, clinical records, and START selection.
Open documentDocument a seven-day delay or denial.
Continue required authorization, exception, or appeal activity while START product is used.
The clinic submits the Celltrion CONNECT form and prescription, documents a seven-day delay or denial, and continues plan-required access work while the hub evaluates START eligibility.
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 And Clinic Staff, Celltrion CONNECT, Patient, Health Plan, Specialty Pharmacy
Celltrion CONNECT
Enrollment, savings, benefits, authorization, temporary access, Nurse Connector, and patient assistance.
Monday-Friday, 8 AM-8 PM ET
Comprehensive official support page with current temporary-access rules.
Official combined enrollment form with three submission paths.
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Patient authorization, Prescription, Insurance cards, Clinical records, Seven-day delay or denial evidence
Submit the completed form by fax to 1-833-912-3707.
Owner: Clinic staff
After enrollment: If approved, Celltrion CONNECT coordinates product fulfillment and tracks coverage progress with the clinic.
If there is a problem: Call before the first or next planned dose if the seven-day threshold has passed and START status or shipment is unresolved.
