Patient Assistance options
You may be eligible to receive free Xen if you:
- Have been prescribed Xen
- Have limited or no health insurance coverage
- Live in the United States
- Are being treated by a licensed U.S. health care provider on an outpatient basis
If you have insurance, we will review your qualifying financial need based on a combination of your insurance coverage, household income, and out-of-pocket medical expenses during the application process. To help you understand the income guidelines that we use to evaluate qualifying financial need, we’ve provided the table below:
| Household size | Annual income |
| 1 | $77,280 or less |
| 2 | $104,520 or less |
| 3 | $131,760 or less |
| 4 | $159,000 or less |
| After 4, add $27,240 for each additional dependent family member |
If you would like to apply, you should work with your healthcare provider to submit a program application. To avoid delays, please follow the instructions on the first page and submit all requested information. Please download the application below.
Xen application (Spanish)