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- RemiStart® Enrollment Form
Patient Rebate Program for REMICADE®
For eligible patients enrolled in the RemiStart® Program
You pay $5 per infusion*
*Program exhausts after 12 months, or a maximum annual benefit of $10,000, whichever comes first.
(See RemiStart® Extended Access Program for continuing support after 12 months.)
Complete and sign enrollment form, obtain physician's signature, and submit enrollment form to RemiStart®.
Fax: (877) 234-3048, or Mail: 14001 Weston Parkway, Suite 103, Cary, NC 27513
Medication rebate for people receiving or beginning treatment with REMICADE® (infliximab)
Based upon your eligibility, RemiStart® can provide a rebate for your medication out-of-pocket costs, including deductible, co-payment, and co-insurance, for up to 12 months, for a maximum annual benefit of $10,000.
Am I eligible for a RemiStart® rebate?
You may be eligible for a rebate from RemiStart® if you:
- Are beginning or are currently receiving treatment with REMICADE®
- Currently have commercial insurance that covers medication costs for REMICADE®
- Have a medication out-of-pocket expense greater than $5 per infusion
Please click here for other Restrictions which may apply.
The cost of IV infusion services are not covered by this program.
|Up to a year of support||Program exhausts 12 months after first service date or $10,000, whichever comes first. Click here for other Restrictions.|