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 you carry Medicare 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 The XHANCE Patient Assistance Program can be changed, rescinded or revoked at any time without prior notice.

APPLICATION INFORMATION

How do I apply?
Download and complete the application form. Call (833) 942-6231 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 (optinosepap@msmpatientservices.com), or over the phone (833-942-6231).

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 be notified of approval/denial within one week after the application is received and determined to be complete.


OptiNose US, Inc. understands that your privacy is important. By providing your name, address, and other requested information, you are giving OptiNose US, Inc., and other parties working with us, permission to communicate with you about XHANCE or other products, services, and offers from OptiNose US, Inc. We will not sell your name or other personal information to any party for its marketing use. Click here to view the privacy policy.

MEDICATION DETAILS

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 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 (833) 942-6231 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.