Synagis Copay Assistance Program^†

What type of user are you?

In order to participate in the Synagis Copay Assistance Program (Program), a patient must have commercial insurance for Synagis. The Program is not valid for patients whose prescriptions 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. This offer is not valid for cash paying patients. The Program is void where prohibited by law. Certain rules and restrictions apply. Sobi reserves the right to revoke, rescind or amend this offer without notice. This Program is not insurance.

For pharmacy benefits this offer is not valid for claims and transactions submitted more than 180 days from the date of service. For medical benefits this offer is not valid for claims and transactions submitted more than 270 days from the date of service. Additionally, claims submitted under a medical benefit will need to include an explanation of benefits from the insurance provider showing the dollar amount the insurance provider covered for the dose of Synagis.

Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this Program. This Program is not conditioned on any past, present, or future purchase, including refills. If you have any questions, please contact Synagis Connect at 1-833-SYNAGIS (1-833-796-2447) (8:00AM-8:00PM EST Monday - Friday)