Patient assistance
May provide CIMZIA to eligible uninsured, underinsured, or financially burdened patients with gross household income at or below 500% of the federal poverty level.
What it does
The program reviews income, residence, insurance, financial hardship, prescription, and provider information. Insured applicants generally must exhaust other coverage and assistance options; CIMZIA applicants with government insurance are excluded under the current application.
Open official program pagePotentially available to eligible US or territory residents who are uninsured, underinsured, or experiencing significant financial hardship and have gross household income at or below 500% of the federal poverty level.
Government program exclusions: Medicare, Medicaid, TRICARE, VA, DoD, Other government programs for CIMZIA
Complete and sign the patient section of the current UCB application.
Open documentPatient and prescriber complete their sections of the UCB application and submit income, insurance, hardship, and prescription records by fax, email, or mail using the current form instructions.
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
Patient, Prescriber And Clinic Staff, UCB Patient Assistance Program
CIMplicity
Enrollment, savings, Nurse Navigator, training, tracking, and sharps support.
Monday-Friday, 8 AM-8 PM ET
UCB Patient Assistance Program
Patient-assistance application and status.
Current application states a gross household income threshold at or below 500% of the federal poverty level and product-specific insurance rules.
UCB patient financial-assistance overview.
Provide household-income records requested by the program.
Provide insurance cards, denials, and other available-option documentation.
Complete the provider section and valid US prescription.
Prescriber completes the prescription, clinical, insurance, and service-selection sections and attaches supporting records.
Owner: Prescriber or clinic staff
Have ready: Patient authorization, Income evidence, Insurance or hardship evidence, Provider section, Prescription
Submit the completed form by fax to 1-855-880-5262.
Owner: Clinic staff
Best for: Applicants needing assistance with the UCB application
Provide the requested prescription, insurance, contact, and consent information.
Owner: Patient or caregiver
Have ready: Prescription details, Insurance card, Prescriber contact information
After enrollment: UCB communicates the eligibility decision and medicine-delivery process if approved.
If there is a problem: Call or email the program to identify missing income, insurance, hardship, prescription, or signature information.
