患者协助选择
您可能有资格获得免费的Delzicol胶囊：
- Have been prescribed Delzicol capsules.
- Have limited or no health insurance coverage
- 住在美国
- Are being treated by a licensed U.S. health care provider on an outpatient basis
如果您有保险，我们将根据申请过程中的保险，家庭收入和自付费用的结合来审查您的资格财务需求。为了帮助您了解我们用来评估合格财务需求的收入指南，我们提供了以下表：
| 房子大小 | 年收入 |
| 1 | $ 81,540或以下 |
| 2 | $ 109,860或以下 |
| 3 | $138,180 or less |
| 4 | $ 166,500或以下 |
| After 4, add $28,320 for each additional dependent family member |
如果您想申请，则应与您的医疗保健提供商合作提交计划申请。为了避免延迟，请按照第一页的说明进行操作，并提交所有请求的信息。请下载下面的应用程序。
Delzicol应用（西班牙语）
Medicare患者可能有资格Medicare的额外帮助。
Available to patients with commercial prescription insurance coverage who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not健康保险。