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

This program provides brand name medications at no or low cost

Provided by: Gilead Sciences, Inc.


TEL: 844-622-2377


FAX: 855-553-8672
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Zydelig AccessConnect Enrollment Form

Zydelig AccessConnect Enrollment Form (Spanish)

 

Brand Name Medications Covered

 
  • Zydelig tablet
 

Generic Name

 
  • idelalisib tablet
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes, but contact program for details
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be a US resident and treated by a US licensed healthcare provider
   

Application

Obtaining Call for prescreening
Receiving Faxed
Returning Fax
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach copies of proof of income, residency and other requested documentation
Decision Communicated Call for decision
Decision Timeframe Up to 10 business days
   

Medication

Amount/Supply Up to 30 day supply
Sent To Patient's home
Delivery Time Within 4-10 business days
Refill Process Patient contacts pharmacy
Limit Contact the program for details
Re-application New application yearly
   

Additional Information

The ZYDELIG QuickStart Program provides a free 30-day supply for eligible patients who face an insurance coverage delay of more than 5 business days.

This program also provides copay assistance for insured patients.


Updated May 23, 2017