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Chemo Mouthpiece Patient Assistance Program

 

Eligible patients may pay $0 for their Chemo Mouthpiece Patient Kit
via the Patient Assistance Program. Terms & Conditions apply.

 

Patients seeking to participate in the Assistance Program must complete and sign the “Patient Assistance Program“ section of the prescription form, which requires patients to add their Annual Household Income and Number of People Living in Household. Zeal Specialty Pharmacy will process all prescriptions and administer the Patient Assistance Program.

 

Program Details

  • The Chemo Mouthpiece® Patient Assistance Program provides devices at no cost to eligible patients.
  • The program is completely free to enroll.
  • An authorized healthcare provider must prescribe the device on the patient’s behalf.
  • Approval depends on product availability and verification of eligibility.
  • There is no purchase requirement.
  • The product may not be resold or billed to insurance or any third party.

 
If you have already received a bill for your Chemo Mouthpiece Patient Kit, you may still be eligible for the Patient Assistance Program. Contact us at: .

 

Six blue Chemo Mouthpiece devices in front of a pink and a grey cooler.