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All eligible commercially insured patients pay $25 or less ...
All eligible commercially insured patients pay $25 or less for AUVI-Q* OR *Terms and Conditions: Only valid for commercially insured patients in the 50 United States and DC through the direct delivery service and/or designated retail pharmacies. Limit two (2) cartons of AUVI-Q per dose, per patient each calendar year. Individual
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Frequently Asked Questions Obtaining AUVI-Q …
www.auvi-q.comDoes Tricare cover AUVI-Q? We encourage you to discuss with your doctor and contact Tricare requesting coverage as AUVI-Q may be covered by Tricare with a patient co-pay.
kaléo Cares Patient Assistance Program Enrollment Form
www.auvi-q.comkaléo Cares Patient Assistance Program Enrollment Form WEB DOWNLOAD Please fax completed forms from prescriber’s office to: (800) 943-1730 kaleo, Inc (kaléo), the maker of AUVI-Q, understands that some patients may have financial difficulties that prevent them from obtaining necessary medications.
Ask your doctor if AUVI-Q is right for you. (844) 357-3968 ...
www.auvi-q.comDrug: AUVI-Q® (epinephrine injection, USP) £ 0.1 mg £ 0.15 mg £ 0.3 mg Dispense as Written: £ Yes ICD Diagnosis Code: £ Quantity: £ 1Carton(2 auto-injectorsand1trainer) £ 2Cartons(4 auto-injectorsand2trainers) £ Other: Refills: £ 1 £ 2 £ Other: Locations for EAI: £ Home £ Work £ School £ Other:
CM-US-AQ-1636 kaléo Cares Patient Assistance Program ...
www.auvi-q.comkaléo Cares Patient Assistance Program Enrollment Form Web Download Please fax completed forms from prescriber’s office to: (800) 943-1730 For assistance with any questions, call 502-213-7601 • Monday through Friday from 8am to 7pm Eastern Standard Time For additional information on AUVI-Q, please visit our website AUVI-Q.com ©2020 kaleo, Inc.
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