Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  

RELiZORB Patient Assistance Program

Provided by: Alcresta Therapeutics, Inc.

c/o RELiZORB Support Services
2560 Lord Baltimore Drive
Suite 222
Baltimore, Maryland 21244

TEL: 844-735-4967

FAX: 844-890-1900
Languages Spoken:


Program Website


Patient Assistance Applications

RELiZORB Patient Assistance Program Enrollment Form

RELiZORB Patient Assistance Program Order Form

RELiZORB Patient Guide


Brand Name Medications Covered

  • Relizorb cartridge

Generic Name

  • immobilized lipase cartridge

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed product
Those with Part D Eligible? No
Income Determined case by case
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Not specified


Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Varies


Amount/Supply Varies
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified

Additional Information

Updated July 21, 2017