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Perforomist Patient assistance program

Is your Perforomist medication too expensive? Start receiving your medication for only $49 per month.*

Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Perforomist medication with our help.

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  • NiceRx Benefit
    Secure: Your personal and medical information is safe with us
  • NiceRx Benefit
    Convenient: Your medication is delivered straight to your door
  • NiceRx Benefit
    Ongoing refills: Your medication is refilled automatically
  • NiceRx Benefit
    Secure: Your personal and medical information is safe with us
  • NiceRx Benefit
    Convenient: We manage the whole process and we’re here to assist you
  • NiceRx Benefit
    Ongoing refills: We request your medication refills on your behalf

NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.

An introduction to NiceRx

Play video (01:52)
  • An introduction to NiceRx
    (01:52)
  • Next steps after qualifying
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  • Uploading documents and billing
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  • SSN & billing information
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  • Medication delivery time
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How it works

  • Apply Online

    Get started by filling out the online enrollment application to find out if you are eligible.

  • Qualification

    NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified. The pharmaceutical company provides your medication for free and you only pay our service fee.

  • Upload Documents

    You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.

  • Application Created

    Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.

  • Receive Medication

    Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.

Medically reviewed by  Jamie Winn, PharmD

Your monthly Perforomist cost savings if eligible

If you are eligible to receive your Perforomist prescription through the patient assistance program, your medication will be free. We charge a flat monthly service fee of $49 per medication to cover the cost of our services.

Am I eligible for Perforomist patient assistance?

To be eligible for the Perforomist patient assistance program, you will need to meet specific eligibility criteria set by the pharmaceutical company. At NiceRx, we review each Perforomist enrollment application individually. The main factors considered are:

  • I am a permanent, legal resident of the United States or Puerto Rico
  • I am uninsured or my insurance doesn’t cover my medication
  • I meet certain income eligibility requirements

How do I apply for the Perforomist patient assistance program?

Applying for the Perforomist patient assistance program through NiceRx is simple. Begin by completing the enrollment application on our website. We will ask for details about your healthcare provider, your insurance plan, and your household income. This information is required by the pharmaceutical manufacturers that supply your medication. We may be able to help you access patient assistance for other medications as well as Perforomist, so please tell us about any medications that you have been prescribed.

If we determine that you may be eligible for Perforomist assistance, we will handle the full enrollment process on your behalf. We will work with your healthcare provider to prepare and submit all the documents required for you to enroll. If you are successfully enrolled in the Perforomist patient assistance program, we will also request your Perforomist medication refills on your behalf for up to 1 year. At the end of your enrollment period, we will contact you for updated details and seek to re-enroll you in the program.

Is NiceRx a Perforomist coupons provider?

NiceRx does not provide Perforomist coupons, discount cards or copay cards. We do not offer printable Perforomist manufacturer coupons, Perforomist discounts, rebates, Perforomist savings cards, trial offers, or free samples. We are a service provider that helps eligible individuals access patient assistance programs. Our service cost is $49 a month per medication, so you will likely save more on your Perforomist medication with NiceRx.

Can NiceRx help me get Perforomist if I have insurance?

NiceRx may be able to help you access Perforomist patient assistance if:

  • You have a high copay or coinsurance responsibility for Perforomist
  • Your insurance company will not pay for your Perforomist prescription
  • You do not have insurance

Complete your enrollment application online to find out more.

How much does Perforomist cost without insurance?

Perforomist prices without insurance will vary by retailer. As a guide, Perforomist inhalation solution (20 mcg/2 mL) will typically cost around $600 for 60 milliliters.

How much does Perforomist cost with insurance?

Your individual healthcare plan will determine the copay of Perforomist with insurance. To find out what you will need to pay, contact your pharmacist or insurance provider. They will be able to calculate your copay with your current insurance.

What is Perforomist?

Perforomist (formoterol fumarate) inhalation solution is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Mylan. It is a long-acting beta 2-adrenergic agonist (beta2-agonist) indicated for the long-term, twice daily (morning and evening) administration in the maintenance treatment of bronchoconstriction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.

Perforomist inhalation solution is not recommended to treat acute deteriorations of chronic obstructive pulmonary disease or for the treatment of asthma.

Long-acting beta2-adrenergic agonists (LABA) increase the risk of asthma-related death. A placebo-controlled study with another long-acting beta2- adrenergic agonist (salmeterol) showed an increase in asthma-related deaths in patients receiving salmeterol. The finding of an increased risk of asthma-related death with salmeterol is considered a class effect of LABA, including formoterol.

What doses of Perforomist are available?

Perforomist is available in inhalation solution (unit dose vial for nebulization) form, in the following doses: 20 mcg/2 mL solution.

For oral inhalation use only, one 20 mcg/2 mL vial every 12 hours. Use with a standard jet nebulizer (with a facemask or mouthpiece) connected to an air compressor.

Please see the full prescribing information for the complete boxed warning and always speak with a healthcare professional for medical advice or about any changes to your dose so they can monitor and evaluate your condition.

Perforomist active ingredients

Perforomist inhalation (formoterol) is a long-acting bronchodilator. It relaxes muscles in the airways to improve breathing.

Perforomist side effects

The most common side effects of Perforomist in clinical trials include:

  • Diarrhea
  • Nausea, vomiting
  • Nasopharyngitis
  • Dry mouth
  • Dizziness
  • High blood pressure
  • Trouble sleeping

In rare instances, Perforomist can cause more serious side effects. These can include:

  • Severe dizziness
  • Fainting
  • Irregular heartbeat
  • Muscle cramps
  • Chest pain
  • Life-threatening paradoxical bronchospasm
  • Serious allergic reactions include rash, hives, swelling of the face, mouth, and tongue, and breathing problems

Your doctor will assess the benefits of using Perforomist against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Perforomist to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Perforomist drug interactions

Perforomist can interact with other medications. These include:

  • Other adrenergic drugs
  • Xanthine derivatives, steroids, diuretics, or non-potassium sparing diuretics
  • MAO inhibitors, tricyclic antidepressants, and drugs that prolong QTc interval
  • Beta-blockers

This list is not exhaustive and other prescription drugs may interact with Perforomist. Tell your healthcare provider about all the medicines you take including prescription and over-the-counter medicines, vitamins and herbal supplements.

Perforomist contraindications

You should not use Perforomist if you:

  • Are allergic to the active ingredient formoterol fumarate
  • Are allergic to any of the other ingredients in Perforomist
  • Are not using an inhaled corticosteroid for asthma

Talk to your doctor before using Perforomist if you:

  • Are taking any of the medications that could interact with Perforomist
  • Have cardiovascular or convulsive disorders
  • Have thyrotoxicosis
  • Are sensitive to sympathomimetic drugs
  • Are pregnant or are planning to become pregnant
  • Are breastfeeding or are planning to breastfeed

Perforomist generic

Perforomist is the trademark brand name for formoterol fumarate manufactured by Mylan. A generic version of formoterol fumarate is available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Perforomist savings through NiceRx.

*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking the different programs and filling out all the required paperwork for each program. Subject to medication availability.

Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.

**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).

To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.

The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.