Farxiga Patient Assistance Form
Are you or a loved one prescribed Farxiga but struggling with the cost? You may qualify for the Farxiga Patient Assistance Program, which helps eligible patients get this medication at little to no cost.
Who Can Apply?
- Patients with financial hardship
- Those without insurance or inadequate coverage
- U.S. residents meeting specific income requirements
How to Get the Farxiga Patient Assistance Form?
- 1️⃣ Visit the official manufacturer’s website or patient assistance portals.
- 2️⃣ Download the application form.
- 3️⃣ Fill out personal, financial, and prescription details.
- 4️⃣ Have your doctor complete and sign the required sections.
- 5️⃣ Submit via mail, fax, or online as per instructions.