co-pay assistance

of up to

$
125

per month for 14 months*

*Click here for additional Information.

How the core connections
co-pay assistance program works:

  • 1. Present this card with a valid prescription.
  • 2. You will receive co-pay assistance for up to $125 for a 1-month supply. This card is valid for 14 months
  • 3. If you have any questions, please feel free to call 1-855-336-3322

In order to receive co-pay assistance, you must register for the CORE Connections co-pay assistance program. To register, simply fill out the form to the left with your valid information.

After all information is supplied, please click Submit to complete your registration. After the registration is complete, you will be prompted to print your co-pay assistance card.

Do not refresh your browser until the registration is complete and you have printed your card.

Take this card and your valid prescription to your pharmacist to fill your prescription.

To make sure each patient is benefiting from the CORE Connections co-pay assistance program, Medexus Pharma, Inc. would like to send you periodic emails about updates to the program. However, an email address is not required to register for the CORE Connections co-pay assistance program. Providing your email address acknowledges that you would like to receive future information regarding the CORE Connections co-pay assistance program.

Medexus Pharma, Inc. respects and values your privacy and any information you provide to us. Information will only be used by Medexus Pharma, Inc. and its contracted third parties. Medexus Pharma, Inc. will never sell or transfer your personal information to any party other than Medexus affiliates and third parties in order to support the CORE Connections co-pay assistance program.

Indications and Important Safety Information, Including Boxed Warning

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