Perforomist

Indicated For

COPD

About This Medication

# Viatris Patient Assistance Program Patient Guide: How to Get Perforomist (formoterol fumarate) at Low or No Cost Perforomist (formoterol fumarate) is a long-acting beta2-adrenergic agonist (LABA) used as a maintenance treatment to control symptoms of COPD, including chronic bronchitis and emphysema, in adults. **This guide explains the Viatris Patient Assistance Program (PAP)**, which provides Perforomist **free of charge** to eligible U.S. residents with demonstrated financial need who are uninsured or underinsured without prescription drug coverage.[1][2][3] ## About Perforomist **Perforomist** is an inhaled solution delivered via a nebulizer. It helps relax muscles in the airways, making breathing easier for people with COPD—a progressive lung disease causing airflow blockage and breathing difficulties. Unlike short-acting bronchodilators for quick relief, Perforomist is for daily maintenance use, typically twice daily. It's FDA-approved for COPD but not for asthma without an inhaled corticosteroid. Common side effects include tremor, dry mouth, and dizziness; serious risks involve worsening breathing or heart issues—always consult your doctor.[1] ## Who Qualifies for the Viatris PAP? The program targets patients facing financial hardship. Key requirements: - **U.S. residency**: Must live in the United States or U.S. territories (e.g., Puerto Rico).[2][3][5] - **Financial need**: Assessed individually based on income and household details—no fixed Federal Poverty Level (FPL) threshold listed; "demonstrated financial need" is key.[1][2] - **Insurance status**: Fully uninsured or insured but **without prescription drug coverage** (e.g., no Medicare Part D, Medicaid drug benefits).[2][3][9] - **Prescription**: Valid U.S. prescription for an FDA-approved use by a licensed healthcare provider.[2][3] Medicare patients typically don't qualify due to Part D coverage, unless they have no drug benefits (rare). Underinsured patients without RX coverage may apply.[2][3][7] ## Income Eligibility Breakdown Viatris PAP evaluates **financial need** case-by-case, without published FPL percentages or household size thresholds. Provide detailed income proof (e.g., tax returns, pay stubs). Here's a general sense based on similar programs—**your eligibility is determined individually**: | Household Size | Estimated Max Annual Income (300% FPL example)* | Notes | |---------------|-----------------------------------------------|-------| | 1 (Individual) | ~$45,000 | Assessed per application[1][2] | | 2 (Couple) | ~$61,000 | Includes all household income | | 3 | ~$77,000 | Proof required for all sources | | 4 | ~$92,000 | No assets test specified | *Illustrative; not official Viatris limits—call (888) 417-5780 for your situation.[1][5] Approval isn't guaranteed by income alone.[2] ## Insurance Requirements - **Uninsured**: No health or prescription coverage—ideal candidates.[2][3][9] - **Underinsured**: Allowed if **no prescription drug insurance** (e.g., medical-only plans). Medicare Part D, Medicaid, VA, or TriCare drug benefits disqualify.[2][3][7] - Viatris verifies coverage; falsifying info risks denial.[2] ## Step-by-Step Application Process The program uses **multiple methods** (phone, fax, email). Applications must be **complete, signed**—incomplete ones delay or deny.[2][3] 1. **Confirm eligibility**: Call **(888) 417-5780** (M-F, 8AM-5PM CST/EST) or visit viatris.com to check Perforomist availability.[1][5] 2. **Gather documents**: - **Proof of residency** (e.g., driver's license, utility bill).[2][7] - **Proof of income** (e.g., 2025 tax return, W-2s, pay stubs, SSI award).[2] - **Prescription** (current, from U.S. doctor).[2][3] - Patient/doctor signatures on form.[2] 3. **Download/complete form**: Get from viatris.com (select Perforomist).[1][2] 4. **Submit**: - **Phone**: (888) 417-5780 for help.[1] - **Fax**: 866-792-7945 or 877-427-7290.[2][3][5] - **Email**: ViatrisPAP@Cardinalhealth.com or ViatrisPAP@viatris.com.[2][3] 5. **Follow up**: They'll contact for missing info (e.g., within 5 business days).[4] **Tip**: Doctor's office can assist—many handle prescriber sections.[2] ## Timeline and Delivery - **Processing**: Varies; some notifications in 3-5 business days after complete submission. Full review individually.[3][4] - **Approval duration**: **12 months**, up to **11 refills**.[3][5] - **Delivery**: **Shipped free to your home** (or doctor's office sometimes).[1] - **Reauthorization**: **Required** annually—resubmit proof of continued need.[3] Expect medication in 2-4 weeks post-approval; call for status.[5] ## Alternatives if Denied - **Appeal**: Provide more docs or clarify finances.[2] - **Other programs**: NeedyMeds.org, RxAssist.org for COPD aid; state programs; generic formoterol if appropriate.[10] - **Savings cards**: Check Viatris Connect for insured options (not PAP).[10] - **Doctor samples** or patient access services via Viatris Advocate.[8] - **Generic nebulized formoterol** (if available) or combo inhalers—discuss with provider. ## Important Disclaimer This guide is for informational purposes, based on publicly available data as of 2026. **Program details can change**—verify with Viatris at (888) 417-5780 or viatris.com. Not medical/financial advice; consult your doctor/pharmacist. Assistance **not guaranteed**; individual assessment applies. Viatris may update rules.[1][2][3] (Word count: 1028)

Program information last verified: March 30, 2026