Apply to UCB Patient Assistance Program
Free UCB medicines for people with household income up to 500% of the poverty level who are uninsured, underinsured, or facing hardship despite insurance. Apply directly with the program; here is what it asks and what happens next.
Who can apply?
| Household | 1 person | 2 people | 3 people | 4 people |
|---|---|---|---|---|
| Yearly income up to | $79,800 | $108,200 | $136,600 | $165,000 |
Total gross household income cannot exceed 500% FPL. If no household income, send a signed letter explaining this.
Uninsured, underinsured, or insured with significant financial hardship. Insured patients with approved coverage are considered only after exhausting all other coverage options. Cimzia excludes all government coverage. Program will not talk with representatives of third parties such as alternate funding programs.
Then what?
Sign
- patient application
- Fair Credit Reporting Act authorization (credit-based income check)
Attach
- valid prescription
- proof of income if requested
- no-income letter if no household income
Your prescriber
- completes prescriber application and prescription
Send
- Fax 1-855-880-5262
- Mail to UCB Patient Assistance Program, 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067
Questions: call UCB Patient Assistance Program at 1-877-785-8906. Length of enrollment not stated.
Free. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.