XOSPATA Patient Savings Program
The XOSPATA Patient Savings Programa is for eligible patients who have commercial prescription insurance. The Program parameters are as follows:
- Patients may pay as little as $0 per prescription
- Patients will be enrolled in the Program for a 12-month period
- There are no income requirements
ENROLLING IN THE XOSPATA PATIENT SAVINGS PROGRAM
You can begin the Program enrollment process by following these steps:
Step 1: Click here to enroll
- Click on PATIENT
- Click on ENROLL
- Answer the questions and hit SUBMIT
Step 2: Verify your email address
- You will receive an email with an ID code
- Click on the link in the email and enter the ID code as instructed
- Hit SUBMIT
Step 3: Provide your XOSPATA Patient Savings Program information
- When filling your prescription for XOSPATA, give the specialty pharmacy your XOSPATA Patient Savings Program information
For more information or help enrolling in the XOSPATA Patient Savings Program, please call 1-855-221-3493, Monday–Friday, 8:00 am–8:00 pm ET.
aBy enrolling in the XOSPATA Patient Savings Program ("Program"), you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions: The Program is for eligible patients with commercial prescription insurance for XOSPATA® (gilteritinib). The Program is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, Puerto Rico Government Insurance, or any state patient or pharmaceutical assistance program. Patients who move from commercial insurance to federal or state health insurance will no longer be eligible, and agree to notify the Program of any such change. Patients agree not to seek reimbursement from any health insurance or third party for all or any part of the benefit received by the patient through the Program. This offer is not conditioned on any past, present, or future purchase of XOSPATA. This offer is not transferrable and cannot be combined with any other offer, free trial, prescription savings card, or discount. This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, Puerto Rico, Guam and Virgin Islands. This offer is not valid for cash paying patients. This Program is void where prohibited by law. No membership fees. It is illegal to sell, purchase, trade, counterfeit, duplicate, or reproduce, or offer to sell, purchase, trade, counterfeit, duplicate or reproduce the card. This offer will be accepted only at participating pharmacies. Certain rules and restrictions apply. Astellas reserves the right to revoke, rescind, or amend this offer without notice.
XOSPATA® is a registered trademark of Astellas Pharma Inc.