Cimzia Patient Assistance Application 'link' -

You must be uninsured or have no prescription drug coverage. Patients with Medicare Part D may be eligible and are encouraged to apply for a case-by-case determination.

You can fax the completed application to 1-855-880-5262 or mail it to the UCB Patient Assistance Program office in Houston, TX. Contact and Support cimzia patient assistance application

: If you do not have insurance, you may apply for the UCB Patient Assistance Program (PAP) . This requires a more detailed application, including proof of income and a physician's section with a written prescription. You must be uninsured or have no prescription drug coverage