Assistance for Patients during COVID-19
The HeartFelt Program offers financial relief to fertility patients whose cycles were canceled as a result of COVID-19 and who have initiated a new cycle. Cash-pay patients who qualify will receive medication replacement of Menopur and generic Ganirelix Acetate Injection 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
• Ganirelix Acetate Injection (generic) – Limit of 5 syringes
• Cash-pay and commercially insured prescriptions
• Cycle was canceled due to COVID-19 between March 1 – December 31, 2020
• New cycle was initiated between June 15 – December 31, 2020
• Patient was taking Menopur during the canceled cycle
2. Complete the program application along with your physician.
3. Email the following documents to [email protected]:
– 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
4. 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)