Patient Assistance Program (XMPI PAP)

Fully cognizant of the burden Filipino patients face due to the burgeoning out-of-the-pocket healthcare expenses, particularly for medicines, this program is our small way of bridging some gaps. The goal of XMPI PAP is to make healthcare more accessible by providing free medicines to eligible patients who are spending for maintenance treatment. This program aims to improve treatment adherence and which will ultimately lead to better treatment outcomes. Through this initiative we hope to provide Quality Pharmacotherapy and Favorable Pharmacoeconomic Option.

3 Easy steps to get free medicines.

Know if you're eligible.

Then, accomplish the Registration Form below.

Get your Redemption Voucher Code through e-mail.

Present your Voucher Code

at the drugstore to claim

What are the Free Meds provided by XMPI PAP?

GENERIC NAME

Memantine 10mg FCT

Olanzapine 10mg FCT

Escitalopram 10mg FCT

Sertraline 50mg FCT

Levetiracetam 500mg FCT

XOLVEMED BRAND

Xolvmantine

Xolvprex

Xolvpro

Xolvof

Xolvecetam

How to avail of XMPI PAP?

To avail of XMPI PAP, interested patients must register through XMPI website at www.xolvemedpharma.com or through our Xolvemed Pharma Facebook page.
The patient must have been prescribed with any of the medication (in Tab 1)
The patient must have purchased the prescribed medication(s) with the Xolvemed Brand.
The patient must submit a picture of the original prescription bearing the XMPI medication(s) as proof of the MD consultation through XMPI website
www.xolvemedpharma.com or through our Xolvemed Pharma Facebook page.
The patient must submit a picture of the original receipt for the purchase of XMPI medication(s) corresponding to the prescription as proof of Rx filling through XMPI website www.xolvemedpharma.com or through our Xolvemed Pharma Facebook page.
Items 3 and 4 pertain to patients who are applying through the Xolvemed website and the Xolvemed Facebook page to avail themselves of XMPI PAP Free Meds. Patients who want to avail themselves of XMPI PAP and are purchasing their prescribed XMPI medications through designated or participating Drugstores, need to register first and avail themselves of the XMPI PAP Free Meds through those drugstores.
The chart below shows the XMPI PAP Free Meds schedule for every purchase of XMPI medications. It indicates how much Free Meds can be availed corresponding to the quantity of XMPI medication(s) purchased.
XMPI will communicate with the patient on the details of approval and redemption of the free meds through the communication details provided by the registered patient

Quantity Purchased

100

XMPI Free Meds

Who qualifies for the XMPI PAP?

Patient must have a valid or official receipt for the purchase of the prescribed medication(s) with the Xolvemed Brand.
Patient must properly accomplish the Patient Information / Registration Form and submit through XMPI website www.xolvemedpharma.com or through our Xolvemed Pharma Facebook page.
Patient must read and give consent to the Privacy Notice and XMPI PAP Terms and Conditions.
Patient must submit or upload a picture of corroborating Government Issued I.D; any of the following: Phil. National ID, Driver’s License, PWD/Senior Citizens’ I.D., Postal I.D., UMID, Current Passport) through XMPI website www.xolvemedpharma.com or through our Xolvemed Pharma Facebook page.

Be it known that Xolvemed Pharma Inc. offers the Xolvemed Pharma Patient Assistance Program as an private charitable program, not as health insurance. This program provides assistance in the form of medically necessary free medicines to improve treatment adherence and access to medications for all Xolvemed Pharma patients.
Xolvemed Pharm Inc. (XMPI) reserves the right to decide who is eligible or qualified for Xolvemed Pharma Patient Assistance Program (XMPI PAP).
XMPI PAP Free Meds come at no cost. Fee Meds can sometimes be subject to limitations. Delivery costs of medicines and the XMPI PAP Free Meds are not covered by Xolvemed Pharm Inc. (XMPI).
XMPI PAP can be availed for two years from time of approved registration to the program, unless XMPI has ended the Program, or terminated the patient enrollment. XMPI reserves the right to amend, rescind, or discontinue this program at any time without notification.
If the patient will not sign or refuse to give consent in the electronic registration form, XMPI PAP Terms and Privacy Notice will not be eligible for the Program
Patients must voluntarily complete the registration for XMPI PAP by providing truthful, complete and accurate information in the details required for the XMPI PAP Registration.
If the Patient is a minor or unable to accomplish the registration for XMPI PAP, the assistance of a legally authorized representative (such as a guardian) must be reported in the registration form.
Beneficiaries of XMPI PAP should not submit any claims for reimbursement to any third party or government insurer for products provided by the XMPI PAP.
Free Meds received through the XMPI PAP should not be sold, traded, transferred or donated to any patients not participating in the Program.
Submitting a registration that includes information you know to be false or misleading in order to obtain Free Meds from the program could constitute fraud. Patient registrants who knowingly submit such false information for personal gain may be subject to legal action.
Participants in the Xolvemed Pharma Patient Assistance Program (XMPI PAP) agree to receive communications via Facebook messenger, Viber, SMS, phone call or email regarding their participation in the program. This includes information on where to redeem the free meds, related reminders and updates on the program

Xolvemed Pharma Inc. is fully aware that the out-of-pocket expenses for medicines put most Filipinos at a financial disadvantaged; therefore, XMPI will not consider income as a criterion for eligibility. Please read through the application and ensure that you meet all the eligibility requirements and can provide all the necessary documentation when you submit the application. XMPI cannot process an incomplete registration.

Register for FREE

prescribed medicine.

Patient's Information

First name

Last name

Middle Name

Birthday

Month

Day

Year

Age

Sex

Address

House No. , Street Village / Subdivision, Barangay, City, Province Postal Code

Communication Details

Facebook Account

Paste Profile URL

Mobile No.

Preferably used in Viber

This number is my Viber No.

Viber No.

Medical Information

Primary Diagnosis (related to the assistance program):

(Ex. Major Depressive Disorder; Dementia)

Prescribing Physician

Clinic / Hospital Name

Consent & Acknowledgment

Proof of Consultation: Upload your Prescription

Proof of Rx filling: Upload Official Receipt of Xolvemed Pharma Medications

Proof of Identity: Upload 1 valid Government ID.

I've read, understood and agreed with the Terms & Condition above.

I consent to the Privacy Notice.

I agree with the Privacy Policy for Patient Assistance Program.

Xolvemed Pharma Inc.

Patient Assistance Program (XMPI PAP)

3 Easy steps to get free medicines.

What are the Free Meds provided by XMPI PAP?

Register for FREE

prescribed medicine.

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