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

zubsolv

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Zubsolv Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Orexo US, Inc.

PO Box 219
Gloucester, MA 01931

TEL: 888-236-4167


FAX: 888-246-6527
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Zubsolv Patient Assistance Program Application

 

Medications

  • Zubsolv tablet; sublingual (buprenorphine/naloxone)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Yes, if medication is not covered
Income At or below 300% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Yes, with prescription from US doctor
   

Application

Obtaining Call or download
Receiving Faxed, emailed, mailed or downloaded
Returning Email, fax or mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and valid photo ID
Decision Communicated If denied, patient and doctor notified
Decision Timeframe 2-3 weeks
   

Medication

Amount/Supply 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Once approved; within 2-5 business days
Refill Process Patient must contact company
Limit Up to one year
Re-application New enrollment every 6 months
   

Additional Information

This program also provides copay assistance: 1-888-982-7658

*The manufacturer supporting this program does not charge for applying to the program nor for any products applicants receive. Applicants using the services of a commercial advocacy service may have to supply additional documentation. 


Updated November 12, 2018