Teva Total SupportTM can help your patients and their caregivers:
Understand their insurance, Medicare, or Medicaid coverage options to ensure they can start and stay on treatment
Find financial assistance options to ensure continued access to their treatment
Proactively navigate the PA process, including accelerating and/or appealing PAs to prevent delays in starting treatment
Connect with their specialty pharmacy to help ensure seamless, timely delivery
Stay informed, supported, and engaged throughout their treatment with personalized services and one-on-one nurse support
Questions? Call [1-800-887-8100], Monday-Friday, [9 AM-8 PM ET]
Enroll your patient in teva total support today
DOWNLOAD FORMPay as little as $0 per dose
You may be able to save on out-of-pocket costs with the Savings Offer for WELTRUZA.
- This offer is available for commercially insured patients only
- This offer is not available for patients eligible for Medicare, Medicaid, or any other form of government insurance coverage
- To learn more, call [1-800-887-8100], Monday-Friday, [9 AM-8 PM ET]
Out-of-pocket costs may vary. See Terms and Conditions
The WELTRUZA Savings Program is available to eligible patients who have been prescribed WELTRUZA and have commercial prescription insurance. This program is intended for the benefit of patients, not their insurance plans or other third parties.
Maximum program assistance per prescription and annual benefit limits per individual apply and out-of-pocket expenses may vary. Patient is responsible for costs above maximum benefit amounts. This program is restricted to residents of the United States and United States territories, subject to applicable law. Uninsured and cash-paying patients are NOT eligible for this program. Patients enrolled in any state or federally funded healthcare program, including but not limited to, Medicare, Medigap, Medicaid, VA, DOD, TRICARE, Puerto Rico Government Health Insurance Plan, Medicare-eligible patients enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees, are NOT eligible for this program. Teva Pharmaceuticals, Inc. and its affiliates reserve the right to change, rescind, revoke, or discontinue this program at any time without notice. Please see complete Terms and Conditions at WELTRUZATandC.com.
Downloads
Hospital Inpatient Free Trial Program (HIFTP)
Enroll to provide WELTRUZA to eligible inpatient hospitals unable to accept Prescription Drug Marketing Act (PDMA)-compliant samples.
Register
Prior Authorizations, Exceptions, and Appeals Guide
Follow this guide to navigate payer coverage requirements, submit prior authorization and exception requests, manage appeals, and find access resources.
DownloadBelow are highlights from the complete terms and conditions that hospitals and pharmacists must accept before they can participate in the Hospital Inpatient Free Trial Program for WELTRUZATM (the “Program”).
- Program Product is available only to inpatient hospital pharmacies or hospital-certified pharmacies that are supplying pharmacy services to an inpatient hospital (“Participating Inpatient Hospitals” or “PIHs”).
- PIHs must be validly licensed under applicable state law and do not accept Prescription Drug Marketing Act of 1987 (PDMA)-compliant samples. PIH must notify Teva promptly if it begins accepting PDMA-compliant samples.
- Program Product is being provided free of charge to be dispensed to qualifying patients. PIHs will not separately bill the patient, the patient’s insurance carrier, or any government healthcare program for any product dispensed as part of the Program or for any administration services in connection with Program Product.
- Program Product may not be sold, resold, traded, or distributed for sale.
- Program Product will be dispensed only with a valid order from a provider licensed or authorized under state law to prescribe the product requested. The prescribing provider must be identified at the time the Program Product is ordered.
- PIHs will provide Program Product only to qualifying patients. PIHs must ensure that prescribing providers and hospital employees understand the FDA-approved indications for WELTRUZA and that prescribing decisions are in the best interest of the patient.
- PIHs may only administer Program Product to patients for use consistent with its label and only if the prescriber has independently determined that the Program Product is clinically appropriate for that patient and that immediate onsite treatment with Program Product increases the long-term likelihood of a positive treatment outcome.
- PIHs must complete and return a written receipt upon delivery of Program Product.
- PIHs may request and receive trial units up to the Program limits.
- PIHs must have adequate controls to track utilization of Program Product by each patient and must establish adequate controls to ensure that Program Product is appropriately segregated and tracked to ensure compliance with these terms and conditions.
- PIHs will conduct certain monitoring to detect irregularities, such as failure to comply with the terms and conditions of participation or to submit forms acknowledging receipt of Program Product.
- PIHs, prescribing providers, and patients, as applicable, are under no obligation to prescribe, continue using, or recommend Teva products, including Program Product, as a condition of receiving any Program Product.
- Program Product is commercially labeled as trade product and not labeled as samples.
- The Program terminates on December 31, 2026. However, Teva reserves the right to terminate the Program at any earlier date. Teva will endeavor to provide notice of any such early termination as early as possible.
- Program registrant’s name and the free trial disbursements may be reported as required by state or federal law. Once reported, this information may be made publicly available.
To register or log in, review enrollment criteria, and read the full HIFTP Terms and Conditions, visit weltruza.inpatientrxtrial.com.