INTRODUCING THE XHANCE
PATIENT ASSISTANCE PROGRAM
Through this program, patients who meet certain income and other eligibility requirements may be eligible to receive XHANCE for free for up to six months. Please see below for more detailed information, including how to apply for the program.
ELIGIBILITY AND REQUIREMENTS
What does my income have to be in order to qualify for this program?
At or below 200% of the Federal Poverty Level guidelines.
Is US residency required to qualify?
Yes, patients must be legal US citizens and reside in one of the 50 US states, the District of Columbia, or Puerto Rico.
Am I eligible if I have Medicare coverage?
Yes, unless your Medicare plan includes prescription drug coverage (Part D).
Eligibility for the XHANCE Patient Assistance Program is subject to approval by the XHANCE Patient Program Administrator. Submitting an application to the XHANCE Patient Assistance Program does not guarantee program approval. The XHANCE Patient Assistance Program can be changed, rescinded or revoked at any time without prior notice.
How do I apply?
Download and complete the application form. Call 855-204-2410 if you need assistance.
How do I submit the application?
The completed application can be submitted by fax (800-784-9950), mail (XHANCE Patient Assistance, 2325 Heritage Center Drive, Furlong, PA 18925), email (firstname.lastname@example.org), or over the phone (855-204-2410).
How will I know if I am approved?
Patients will be notified directly, by phone or mail, at the phone number or address indicated on the program application.
How long will the approval process take?
Patients will typically be notified of approval/denial within one week after the application is received and determined to be complete.
How much medication can I receive?
Approved patients will receive up to six months of XHANCE. Medication will be shipped in three month intervals.
Where will I receive my medication?
Patients will receive their medication at the address provided on the application.
How long will it take for me to receive my medication?
Patients usually will receive their medication within 3-7 business days after approval.
What is the refill process?
Contact 855-204-2410 when you are in need of a refill.
How long will I qualify for this program if I am approved?
Once approved, patients will receive up to six months of XHANCE and then patients would be required to reapply.