Call ForgingBridges Today:
Call ForgingBridges Today:
See full Terms and Conditions below.
Download and fill out
the Free Trial Form
for your patient
Sign and date
where indicated
Fax the completed form
to
1-877-738-0545
Free Trial Program Terms and Conditions
The ForgingBridges Free Trial Program (“FTP”), sponsored by BridgeBio Pharma Inc. (“BridgeBio”), the manufacturer of Attruby, provides a 1-month supply of Attruby at no cost to patients who meet FTP eligibility requirements and who agree to the FTP terms and conditions by submitting a signed FTP start form. FTP is a free trial offer, intended solely to allow new patients to try Attruby and to determine with their healthcare provider whether Attruby is right for them. There is no obligation to continue use of Attruby after the free trial has been completed. To be eligible, a patient must: (1) reside in the United States or Puerto Rico; (2) have a valid prescription for Attruby for an FDA-approved indication; and (3) be a new patient not currently using Attruby and who has not previously filled a prescription for or received a sample of Attruby, or received Attruby through the FTP. Attruby supplied through the FTP will (i) be dispensed only by a pharmacy designated by BridgeBio; (ii) be delivered only to the patient’s home address (no P.O. boxes) and (iii) not exceed a 1-month supply. It is unlawful for any person to sell, purchase, trade, barter, or export Attruby supplied through the FTP or make an offer to do so. Patients, pharmacists, and prescribers may not seek reimbursement, either directly or indirectly, for Attruby supplied through the FTP from health insurance or any third-party payer, including Medicare, Medicaid, and commercial insurance plans. Patients must not count the value of the FTP product as an expense incurred for purposes of determining patient out-of-pocket costs under any health insurance program, including Medicare Part D True Out-of-Pocket Costs (“TrOOP”). For patients with Medicare Part D coverage, ForgingBridges will notify the patient’s Medicare Part D plan that the patient is enrolled in the FTP and will be receiving Attruby at no cost outside of the Medicare Part D benefit. The FTP does not provide health insurance and is not a discount, rebate, coupon, cost-sharing program, or other form of financial assistance. Obtaining Attruby through the FTP is not contingent on any past, present, or future purchase of Attruby. This offer is limited to one use per patient per lifetime and is non-transferable. To continue a patient on therapy after such one-time use, a separate prescription must be written by the healthcare provider. Use of the FTP is void where prohibited by law and where use is prohibited by the patient’s insurance provider. BridgeBio reserves the right to rescind, revoke, or amend the FTP at any time without notice.
Call ForgingBridges at:
1-888-55-BRIDGE (1-888-552-7434)
Mon–Fri, 8 AM to 8 PM ET
Call ForgingBridges at:
1-888-55-BRIDGE (1-888-552-7434)
Mon–Fri, 8 AM to 8 PM ET
Confirmation of enrollment receipt will be sent to your doctor’s office & we’ll take it from there!