Comprehensive Reimbursement Support

This reimbursement support program was designed with PRIALT prescribers to help appropriate patients get access to PRIALT.

PRIALT Access & Support Program Overview. Click here to download.
For more information about the PRIALT Access and Support Program,
please call 1-855-PRIALT1 (1-855-774-2581).
How can the program help my practice with treatment access for appropriate PRIALT patients?
  • Healthcare providers:

    Before you place a PRIALT order, this program can help determine insurance coverage and explore financial options for appropriate PRIALT patients.

    • Your dedicated Case Manager can provide comprehensive and on-going support.
  • Patients:

    This program can identify ways to reduce out of pocket costs.

After determining a patient is appropriate for PRIALT therapy, office submits the PRIALT Enrollment and Patient Authorization Form.
PRIALT Enrollment and Patient Authorization Form. Click here to download.

Download form, complete mandatory fields, ask patient to sign authorization and fax to 1-855-PRIALT3 (1-855-774-2583).

Your patient can also complete the authorization online through our online Patient Authorization Form at

Your Case Manager will contact you.

Eligible patients with commercial insurance may qualify for the PRIALT Savings Program.
For more information about the PRIALT Savings Program, click here to download.
Please see full Prescribing Information, including BOXED Warning.