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The EOHILIA Patient Support and Copay Program

Step 1
25

Have you been prescribed EOHILIA?

Step 2
50

Would you like an EOHILIA copay card?

Step 3
75

Verify your eligibility for a copay card

*Please select an answer.

Are you a resident of the United States, Puerto Rico, or a U.S. Territory?*
Is your prescription covered, in whole or in part, under any state or federal program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, or TRICARE?*
Step 4
Step 3
Step 2
100

Tell us about yourself

Based on your previous selections you may not be eligible for the EOHILIA Patient Support and Copay Program, but there is still useful information about EOHILIA you may be interested in hearing about. Sign up to stay in the loop.

*Required field.