JazzCares | ZIIHERA HCP

JazzCares is committed to helping your patients get access to their ZIIHERA medication and providing personalized support throughout their treatment

Enroll now so your patients can see if they are eligible for the JazzCares support services described below

ENROLL NOW

JazzCares supports patients and practices with

Benefit Investigation—Helps patients understand their insurance coverage for ZIIHERA

Prior Authorization Support

Appeals Support

Billing and Coding Information

Referrals to Other Financial Assistance

Reduction of out-of-pocket costs for eligible patients

Savings Card—Eligible, commercially insured patients can pay as little as $10 for their ZIIHERA medication, subject to an annual maximum

Patient Assistance Program for eligible patients

Uninsured or underinsured patients who meet certain financial criteria may be eligible to receive ZIIHERA at no cost^a

^aSubject to financial and residency eligibility criteria.

Resources

Patient Support Flashcard:

Information on JazzCares support services for you to help your patients get access to their medication

Download

Sample Letter of Medical Necessity:

Use as a guide to complete the Letter of Medical Necessity to a payer for your patient

Download

Sample Letter of Appeal:

Use as a guide to complete the Letter of Appeal to a payer for your patient

Download

Billing and Coding Guide:

Reference guide with important codes, billing information, and sample claim forms

Download

You can learn more about JazzCares support
offerings by calling

1-833-533-JAZZ (5299)Monday-Friday, 8 AM-8 PM ET

Insurance coverage and plans may vary. The JazzCares program at Jazz Pharmaceuticals provides general information only and is not a guarantee of any coverage or reimbursement outcome. All treatment decisions rest solely with the treating physician or qualified healthcare professional. Jazz Pharmaceuticals reserves the right to terminate or modify this program at any time with or without notice. Other terms and conditions apply.

ZIIHERA is a registered trademark of Jazz Pharmaceuticals, Inc.

US-JPC-2000033/US-JPC-2400024 Rev1124

ZIIHERA is a registered trademark of Jazz Pharmaceuticals, Inc.

JazzCares supports patients and practices with

Reduction of out-of-pocket costs for eligible patients

Patient Assistance Program for eligible patients

Patient Information

Financial Information Required to determine patient assistance program eligibility

Insurance Information Primary insurer

Secondary insurer

Prescriber Information
To be completed by prescribing doctor.

Diagnosis and Clinical Information

Treatment information

Shipping information

Enrollment Form:

Patient Authorization Form:

Resources

Patient Support Flashcard:

Sample Letter of Medical Necessity:

Sample Letter of Appeal:

Billing and Coding Guide:

JazzCares supports patients and practices with

Reduction of out-of-pocket costs for eligible patients

Patient Assistance Program for eligible patients

Patient Information

Financial Information Required to determine patient assistance program eligibility

Insurance Information Primary insurer

Secondary insurer

Prescriber Information To be completed by prescribing doctor.

Diagnosis and Clinical Information

Treatment information

Shipping information

Enrollment Form:

Patient Authorization Form:

Resources

Patient Support Flashcard:

Sample Letter of Medical Necessity:

Sample Letter of Appeal:

Billing and Coding Guide:

Prescriber Information
To be completed by prescribing doctor.