Synjardy XR

Indicated For

type 2 diabetes

About This Medication

# Boehringer Cares Patient Assistance Program: How to Get Synjardy XR at Low or No Cost ## About This Program The **Boehringer Cares Patient Assistance Program** provides **Synjardy XR (empagliflozin/metformin ER) free of charge** to eligible US patients who cannot afford their medication.[1][7] Synjardy XR is a combination medication used to treat type 2 diabetes by helping your body control blood sugar levels more effectively. ## Who Qualifies? You may be eligible for this program if you meet ALL of the following requirements: - **US Residency**: You must be a resident with a physical address within the United States or a US Territory[6] - **Insurance Status**: You are uninsured OR underinsured (your current insurance doesn't adequately cover the medication)[6] - **No Alternative Coverage**: You don't have access to other sources of funding or assistance for your medication[6] - **Income Eligibility**: Your household income falls within the program's guidelines (see table below)[6] **Important Note**: Medicare Part D patients may be eligible if they meet other requirements, including income thresholds.[6] ## Income Eligibility Guidelines Your household income must not exceed the following thresholds: | Household Size | Maximum Annual Income | |---|---| | Individual | $40,000 | | Couple (2 people) | $60,000 | | Family of 3 | $100,000 | | Family of 4 | $150,000 | These thresholds are set at 400% of the Federal Poverty Level.[6] If your household is larger than four people, contact the program directly for your specific income limit. ## Insurance Requirements You must fall into one of these categories: - **Uninsured**: You have no health insurance coverage - **Underinsured**: Your current insurance doesn't provide adequate coverage for Synjardy XR, leaving you with high out-of-pocket costs - **Medicare Part D**: You may qualify if you meet income and other eligibility requirements The program will verify your insurance status as part of the application review process.[6] ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following:[6] - **Proof of Income**: Recent tax return, W-2, pay stubs, or benefit statements (typically from the last 30-60 days) - **Proof of Residency**: Utility bill, lease agreement, or government-issued ID showing your US address - **Current Prescription**: A prescription for Synjardy XR from your healthcare provider - **Proof of Insurance Status**: Insurance card (front and back) or documentation showing you are uninsured ### Step 2: Complete the Application Form Complete the **Boehringer Cares Patient Assistance Program Application** form.[2][4] The application includes: - **Sections 1-4**: Your personal information, household details, income information, and your signature - **Sections 5-6**: Your healthcare provider must complete these sections with their original signature, confirming your diagnosis and that Synjardy XR is medically necessary ### Step 3: Get Your Healthcare Provider's Signature Your doctor, nurse practitioner, or physician assistant must sign Sections 5 and 6 of the application. This confirms: - Your medical need for Synjardy XR - That the medication is appropriate for your condition - Your provider's contact information ### Step 4: Submit Your Application Follow the submission directions on the application form. Applications can be submitted through multiple methods as specified on the form.[4] ### Step 5: Wait for Approval The program will review your application and verify all information you provided. All applications are reviewed according to BI Cares eligibility criteria.[6] ## Timeline and Delivery **Processing Time**: Applications typically take **2-4 weeks** to process after submission.[6] **Delivery Method**: Once approved, your medication will be **shipped directly to you**.[6] You will receive notification of your approval status and shipping details. **What to Expect**: You should receive your first shipment within a reasonable timeframe after approval. The program will provide you with tracking information. ## What If Your Application Is Denied? If you don't meet the program's eligibility requirements, the program will notify you of the reason.[6] Common reasons for denial include: - Income exceeding the program's thresholds - Having adequate insurance coverage - Not meeting residency requirements - Incomplete application or missing documentation **Next Steps if Denied**: - **Review the Denial Letter**: Understand specifically why you were denied - **Check Your Eligibility**: Verify your income, insurance status, and residency - **Explore Alternatives**: Ask your doctor about generic alternatives, manufacturer coupons, or other patient assistance programs - **Contact the Program**: If you believe there was an error, contact the program to discuss your situation - **Reapply**: If your circumstances change (income decreases, insurance coverage ends), you may reapply ## Reauthorization and Refills **Reauthorization is required** to continue receiving medication through this program.[6] You will need to: - Resubmit your application periodically (typically annually) - Provide updated proof of income and residency - Confirm your continued eligibility The program will notify you when reauthorization is needed. Plan ahead to avoid gaps in your medication supply. ## Important Disclaimer This guide provides general information about the Boehringer Cares Patient Assistance Program for Synjardy XR. Program details, eligibility requirements, and procedures may change. For the most current and complete information, contact the program directly or visit the official Boehringer Ingelheim patient assistance website. This information is not a guarantee of eligibility or approval. All applications are subject to individual review and verification.

Program information last verified: March 30, 2026