Bronchitol

Indicated For

Cystic Fibrosis

About This Medication

# Chiesi CareDirect Patient Assistance Program: How to Get Bronchitol at Low or No Cost ## About This Program The Chiesi CareDirect Patient Assistance Program helps eligible patients access Bronchitol (mannitol inhaled) at reduced or no cost if they cannot afford their medication. Bronchitol is an inhaled powder used to help clear mucus from the airways in patients with cystic fibrosis. This program is designed to ensure that financial hardship doesn't prevent you from getting the medication you need. ## Who Qualifies for This Program? To be eligible for the Chiesi CareDirect Patient Assistance Program, you must meet all of the following requirements: - **U.S. Residency**: You must be a legal U.S. resident - **No Prescription Coverage**: You cannot have any prescription coverage for Bronchitol through third-party insurers, including Medicaid, Medicare Part D, private insurance, or any other state or federally subsidized pharmacy benefit program - **Uninsured or Underinsured Status**: You must either have no insurance at all, or have medical insurance with no prescription drug benefits - **Financial Need**: You must demonstrate financial need based on your household income and size - **Valid Prescription**: You must have a valid prescription from a licensed healthcare provider for Bronchitol ## Income Eligibility The program does not publish specific income thresholds. Instead, eligibility is determined on a case-by-case basis based on your household income and size. Your contribution toward the cost of Bronchitol, if any, will depend on your income and household size. To demonstrate financial need, you will need to provide proof of your yearly household income. Acceptable documentation includes: | Documentation Type | Examples | |---|---| | Tax Returns | Federal Tax Return (most recent year) | | Employment Income | Recent pay stubs, W2 forms | | Government Benefits | Social Security statement, disability statement | | Bank Records | Bank statements showing regular deposits | | Other Income | Any other proof of yearly household income | If you do not file taxes, you must provide alternative proof of yearly household income such as pay stubs, bank statements, or government benefit statements. ## Insurance Requirements This program is specifically designed for patients who are **uninsured or underinsured without prescription coverage**. Here's what this means: - **You cannot have prescription coverage** through any third-party insurer for Bronchitol, including private insurance, Medicaid, Medicare Part D, or Health Management Organizations - **If you have any prescription insurance**, you must provide a photocopy of the front and back of your prescription insurance card with your application - **You cannot qualify for federal, state, or private insurance reimbursement** for Bronchitol - If you begin receiving prescription drug coverage under any federal, state, or government-funded healthcare program at any time, you will no longer be able to participate in this program and must notify Chiesi CareDirect to stop participation ## Step-by-Step Application Process ### Step 1: Gather Required Documents Before starting your application, collect the following: - Completed Chiesi CareDirect Patient Assistance Program application form - Valid prescription for Bronchitol from your licensed healthcare provider - Proof of your yearly household income (tax return, pay stubs, bank statement, or government benefit statement) - Photocopy of your prescription insurance card (if applicable) - Proof of U.S. residency ### Step 2: Complete the Application You and your healthcare provider must both complete the application: **What You Need to Do:** - Complete the entire application form - Sign the Patient Certification and Authorization to Disclose Information section - Attach proof of your household's yearly income - Attach a photocopy of your prescription insurance card if you have one - Date your signature (valid for one year) **What Your Healthcare Provider Needs to Do:** - Complete the Healthcare Provider Section of the application - Provide a valid prescription for Bronchitol or complete the prescription on the form - Sign and date the certification section ### Step 3: Submit Your Application Send your completed application and all supporting documents to Chiesi CareDirect using one of these methods: - **Mail**: Chiesi CareDirect Patient Assistance Program, PO Box 30317, Bethesda, MD 20824-0317 - **Fax**: 1-866-410-6241 - **Email**: chiesicaredirect@caremetx.com - **Phone**: 1-888-865-1222 (for assistance with the application process) ### Step 4: Wait for Approval After you submit your application, Chiesi CareDirect will review your information and determine your eligibility. The program will contact both you and your healthcare provider to notify you of the decision. ## Timeline and Delivery The search results do not specify the exact processing time for applications or the method by which Bronchitol will be delivered to you. Contact Chiesi CareDirect at 1-888-865-1222 for information about: - How long it takes to receive a decision on your application - How your medication will be delivered - When you can expect to receive your first shipment ## Refills and Reauthorization This assistance is temporary. You must **renew your eligibility by December 31 of each year** to continue receiving support under the program. Chiesi CareDirect may request additional documentation to verify the information on your application during the renewal process. For information about the refill process and how to request additional supplies of Bronchitol, contact Chiesi CareDirect at 1-888-865-1222. ## What If Your Application Is Denied? If your application for the Chiesi CareDirect Patient Assistance Program is denied, you have several options: - **Contact Chiesi CareDirect** at 1-888-865-1222 to understand why your application was denied and whether you can provide additional information - **Explore Alternative Programs**: Chiesi USA offers other patient support programs. Contact them at 1-888-865-1222 to learn about other options that may be available to you - **Speak with Your Healthcare Provider**: Your doctor may be able to suggest alternative medications or other resources to help you access Bronchitol - **Contact Patient Advocacy Organizations**: Organizations that support patients with cystic fibrosis may have additional resources or assistance programs ## Important Disclaimer This guide provides general information about the Chiesi CareDirect Patient Assistance Program based on publicly available program materials. Program details, eligibility requirements, and procedures may change at any time. For the most current and complete information, contact Chiesi CareDirect directly at 1-888-865-1222 or visit the official Chiesi USA website. This guide is not a guarantee of program eligibility or approval. Each application is reviewed individually, and eligibility is determined on a case-by-case basis.

Program information last verified: March 30, 2026