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Download the REACH4RYTELO Patient Enrollment Form from the program's website.

Complete the form and submit via fax at 1.888.224.2518 Monday-Friday 8 AM – 8 PM ET, or email. A completed form includes signatures from the patient and the health care provider.

Please respond promptly to a request for further information from a Case Manager to avoid any delays. Once a patient has been enrolled in REACH4RYTELO and their benefits investigation has been conducted, a copy of the results of the benefits investigation will be shared. If information is missing, a Case Manager will follow up with you.

The Copay Program

For eligible, commercially insured patients, the REACH4RYTELO Copay Program offers savings up to $10,650 per calendar year. There are no income requirements to participate in the program. This program is not available to patients with government forms of insurance (Medicaid, Medicare, Tricare, VA).

To be assessed for copay program eligibility, the first step is to enroll in REACH4RYTELO by downloading or faxing the enrollment form.

Patient Access Resources

Reach4Rytelo also offers a library of resources to help patients gain access to patient assistance programs and to help navigate barriers to access in Rytelo.

Access these resources on their Patient Access Resources page.