Assistance for Patients during COVID-19 or a Natural Disaster
The HeartFelt Program offers financial relief to fertility patients whose cycles were canceled as a result of COVID-19 or a natural disaster resulting in a state of emergency and who have initiated a new cycle. Cash-pay patients who qualify will receive medication replacement of Menopur at no additional cost. Commercially insured patients who qualify will receive a rebate of up to $250 towards their copay costs.
- Menopur (menotropins for injection) – Limit of 15 vials
- Cash-pay and commercially insured prescriptions
- Cycle was canceled due to COVID-19 diagnosis, COVID-19 treatment facility closure, or a natural disaster resulting in a state of emergency
- Patient must have used Menopur as part of the canceled cycle
- If you were cash-pay for your medications, download the HeartFelt Medication Replacement Application. If you used commercial insurance, download the HeartFelt Co-Pay Assistance Application.
- Complete the program application along with your physician.
- Email the following documents to email@example.com:
- – Completed program application
- – Medical records showing the medications utilized prior to cycle cancellation
- – Proof of purchase (i.e. itemized pharmacy receipt)
- – Prescription for new cycle
- You will be notified via email regarding your application status. If approved, cash-pay patients will be shipped replacement medication at no cost. Commercially insured patients will receive a rebate check within 45 days of approval notification.
HeartFelt Medication Replacement Application (Cash-Pay)
HeartFelt Co-Pay Assistance Application (Commercial Insurance)