IYUZEH^™ PATIENT ACCESS PROGRAMS

IYUZEH CASH PROGRAM

Welcome!

The IYUZEH Cash Program is only available to residents of the United States, except where prohibited. By participating in the IYUZEH Cash Program, patients must inform their health insurance, if their health insurance requires this notification, such as Medicare Part D, that they are purchasing this product outside of their benefits and will not seek reimbursement.

Patients who are insured by a federal, state, or other governmental programs, including but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health benefits coverage, or any other federal or state health care program, are only eligible for the IYUZEH Cash Program if they certify that they will not submit a claim for reimbursement under the payer or prescription plan.

To view Terms and Conditions, please click here.

To activate your cash program card, choose one of the below options:

Have a card

Need a card

To view Terms and Conditions, please click here. This is an annual program and must be renewed accordingly. Before renewing any prescription program, patients should review their healthcare options annually and determine the best program for them.

Please complete the below information to activate your card.

(Do not include any spaces or dashes in your answers.)

1. Enter the 10-digit RxGRP# from your card

Please enter a valid RxGRP#.

2. Enter the 11-digit ID# from your card

Please enter a valid ID#.

3.1.I certify that I, or a caregiver activating on behalf of the patient, am 18 years of age or older and a resident of the United States.

Yes

Selection required.

4.2.By clicking submit below to activate this card, I confirm that I have read, understand and will comply with the Terms and Conditions of the program. I also confirm that I currently meet all eligibility criteria, have read and agree with the Terms and Conditions below.

Yes

Selection required.

Congratulations on your eligibility for the IYUZEH Cash Program!

To complete your card activation, please fill out the information below. Asterisks indicate required fields.

Patient Information

First Name*

Field required.

Last Name*

Field required.

Date of Birth*

Please enter vaild date of birth.

Address 1*

Field required.

Address 2

Field required.

City*

Field required.

State*

Field required.

Zip Code*

Field required.

Email*

Please enter valid email.

Phone*

Please enter valid phone.

Cell Phone

Home Phone

Selection required.

Preferred Method of Contact

Mail

Selection required.

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IYUZEH™ PATIENT ACCESS PROGRAMS

IYUZEH CASH PROGRAM

Welcome!

To confirm your eligibility, you must agree with the below statements.

Please complete the below information to activate your card.

(Do not include any spaces or dashes in your answers.)

Congratulations on your eligibility for the IYUZEH Cash Program!

Patient Information

Congratulations!

IYUZEH^™ PATIENT ACCESS PROGRAMS