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Polivy Patient assistance program

Is your Polivy medication too expensive? Through NiceRx, you may be able to get Polivy 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 Polivy medication.

Get started today
  • Secure: Your personal and medical information is safe with us
  • Convenient: We manage the whole process and we’re here to assist you
  • Ongoing refills: We request your medication refills on your behalf
  • Secure: Your personal and medical information is safe with us
  • Convenient: We manage the whole process and we’re here to assist you
  • 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.

Medication delivery time

Play video (00:41)
  • An introduction to NiceRx
    (01:52)
  • Next steps after qualifying
    (00:38)
  • Uploading documents and billing
    (00:50)
  • SSN & billing information
    (00:33)
  • Medication delivery time
    (00:41)

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.

  • 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.

Your monthly Polivy cost savings if eligible

You can receive your Polivy prescription for a flat fee of just $49 per month. This covers the full cost of your Polivy medicine, regardless of the retail price.

Am I eligible for the Polivy patient assistance program?

If you meet the eligibility criteria, you could receive your Polivy without paying the full retail price. We review each Polivy assistance program application individually. The factors considered by most programs 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 Polivy patient assistance program?

NiceRx takes the stress out of applying for the Polivy patient assistance program. Start by filling in our enrollment application and tell us about any medications you’re taking, including Polivy. We’ll ask for details about your healthcare provider, insurance, and your household income as this is needed by the pharmaceutical manufacturers who ship your medication.

If we determine that you may be eligible for assistance having reviewed your individual information, we’ll help to enroll you in the Polivy patient assistance program and handle the full application process for you. Once you are enrolled in the program, NiceRx will request your Polivy medication refills on your behalf for up to one year.

Does NiceRx provide Polivy coupons?

NiceRx does not provide Polivy coupons or Polivy discount cards. We don’t offer printable Polivy coupons, Polivy manufacturer coupons, Polivy discount coupons, rebates, Polivy savings cards, trial offers, free Polivy, or free samples of Polivy. We are a service provider that helps eligible individuals access the Polivy patient assistance program. When obtaining your Polivy medication through NiceRx, your total cost will always be $49 per month. This is likely to be much cheaper than Polivy coupons.

Can NiceRx help me get Polivy if I have insurance?

If for any reason your insurance company won’t pay for your Polivy medication, you have a high copay or coinsurance responsibility, or you don’t have insurance, we may be able to help.

How much is Polivy with insurance?

The cost of Polivy will often vary by healthcare plan. Your healthcare provider or pharmacist will be able to calculate your copay with your current insurance. Remember, you’ll likely save money if you get your Polivy medication through NiceRx, if you’re approved for assistance.

How much is Polivy without insurance?

Polivy prices without insurance will vary depending on where you purchase it. With NiceRx you’ll always pay a flat monthly fee of $49.

*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 down the different programs and filling out all the required paperwork for each program.

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.

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