Alliance Labs LLC is committed to providing access to our medications for those most in need. If you are experiencing financial hardship and have limited or no prescription coverage, then you may be eligible to receive our medications at discounted pricing. Our customer care department also provides patients with support services, including discounted savings programs and product availability information regardless of their insurance coverage.

It’s easy and free to apply for the Enemeez® Savings Program!

Here’s all you have to do:

  1. Complete the patient assistance application online. Link is listed below for your convenience.
  2. Call us today toll-free at 1-800-650-0113.

This is not health insurance. Terms and conditions do apply.

Eligibility Requirements

  1. You are a legal resident of the United States.
  2. Have limited or no prescription coverage to obtain the medication.
  3. Have no access to alternate sources of coverage or funding.
  4. Your insurance company or state program has denied coverage.
  5. Must meet household income equal to or less than:
  • $50,000 for a single person
  • $70,000 for a family of two
  • $90,000 for a family of three
  • $110,000 for a family of four or more

Program Information

Terms & Limitations

I understand that the Alliance Labs will review my enrollment form, determine my eligibility and notify me based on the information that I have provided.

This program is valid only to legal U.S. residents. The program may be terminated or modified at any time. Alliance Labs reserves the right to revise or revoke this program at any time. If any such revision or revocation occurs, the applicant will be notified either by phone or mail. Quantity restrictions do apply. Each approved participant in this program will not be allowed to purchase more than three, 30 count bottles, per calendar month. Promotional discounts and offers are not valid with the patient assistance program. Patients seeking additional purchases may be required to provide a physical order.

Authorization to use and disclose information

Alliance Labs does not provide/sell personal information to third party companies. I may revoke this authorization by ending my participation in the program by writing to Alliance Labs. 8201 104th St., Suite 200, Pleasant Prairie, WI 53158 or by phone at 1-800-650-0113 or email customer service at [email protected]

Telephone Consumer Protection Act (TCPA) Consent: I consent to receive marketing and non-marketing calls and texts from and on behalf of Alliance Labs, LLC, made by a customer service representative or with an auto-dialer or prerecorded voice or text at the phone number(s) provided. I understand that my consent is not required or a condition of purchase. Number of messages will vary based on your program selections. Message and data rates may apply.

Fair Credit Reporting Act (FCRA) Authorization: I understand that I am providing “written instructions” authorizing Alliance Labs LLC, under the FCRA, to obtain financial information, solely for the purpose of determining financial qualifications for programs administered by Alliance Labs LLC. I understand that I must affirmatively agree to these terms in order to proceed in this financial screening process.

Applicant Information

  • MM slash DD slash YYYY
    By checking YES, you agree that Alliance Labs may contact you about new programs and services, additional products and health information or for market research purposes. If No, Alliance Labs LLC may continue contacting you for transactional details (order confirmations, shipping, etc.), recalls, and other pertinent information.
  • You must include acceptable proof of income

    Acceptable proof of income documents include

    • Federal Income Tax Form (1040, 1040A, or 1040EZ, 1040X, 1722, 8453, 8879, or 100INT)
    • Yearly Benefits Statement (SSA 1099 or 4506T)
    • IRS Telefile worksheet
    • W2 Tax Statement
    • Social Security, Pension, or Railroad Retirement Statements (SSA-1099, 4506T)
    • Statements of interest, dividends, or other income (1099-INT, 1099, 1099T, 1099-DIV)

    Please upload all requested documentation so we may properly process your application for the Patient Assistance Program (Drag and Drop, Multiple Files Accepted) *

  • Drop files here or
    Max. file size: 49 MB.
      (Drag and Drop, Multiple Files Accepted)
    • Important
      By signing, I certify that I have read and understand the program information on this form. Additionally, I certify that the information on this enrolment form, including all copies of income documentation, is accurate and complete and that I am authorized to sign this application. I understand and agree that an administrator of this program will verify my information.