Sign up for the $0 co-pay offer

If you have private or commercial insurance you may be eligible to pay as little as $0 a month* for your ZELTASIA prescription.

Fill out this form to enroll

If you have questions, simply contact an MS Nurse Navigator at
1-833-ZELTASIA (833-555-5555)
Monday to Friday, 8 am to 8 pm ET.

All fields below are required unless indicated as optional.

  • You are a resident of the United States or Puerto Rico
  • You have private, employer-based, or commercial insurance (provided by your employer or directly purchased by you)
  • You do not purchase medications through Medicare, Medicaid, or any other federal or state prescription program
  • You are 18 years of age or older
  • You will fully comply with the terms and conditions of the Program
  • You would like to receive communications from Pharmaceutical Company related to ZELTASIA and the ZELTASIA Co-pay Program, including site updates and patient education, as well as other Pharmaceutical Company products and services
  • The information you have provided is true and correct

See Full Terms and Conditions

Note that if you are enrolled in federally/state-funded health insurance without your knowledge, your card may be rejected.

Gender

Please enter the following information from your health insurance card. Need help finding this information? See a sample insurance card.

Or if you have further questions, please call an MS Nurse Navigator at 1-833-ZELTASIA (833-555-5555) Monday to Friday, 8 am to 8 pm ET.

Are you or your loved one living with MS?

When were you or your loved one diagnosed?
Your answer will only be used to help us send the information that’s most relevant to you.

Are you or your loved one starting and/or currently taking ZELTASIA?

Before ZELTASIA did you ever use another treatment for relapsing MS? (optional)

Which treatment(s) have you used? Select all that apply. (optional)

Which describes you or your loved one? Please select one. (optional)

The ZELTASIA text program

If a mobile phone number is provided, you'll receive important information and updates about ZELTASIA.

Enroll me in the ZELTASIA text program (optional)

Privacy Policy
The information you’ve provided us may be used by Pharmaceutical Company, or parties acting on its behalf, to contact you via mail, telephone, in electronic format or otherwise, in the future, for market research, clinical trials, and other information and offers that it believes to be of interest to you. This information may be provided to other parties that Pharmaceutical Company is working with, including but not limited to its subsidiaries and affiliates, in order to help develop programs and provide services that may be of interest to you, provide educational information, or for processing, mailing, and/or Internet-based delivery purposes. Pharmaceutical Company may also use your information for communication, services, and marketing activities. From time to time the Privacy Policy may change and you should check the website for the most recent version. You can stop future marketing communications and use of your information by calling 833-555-5555. To opt out of text messages, text STOP to the number from which you received a text message. To opt out from e-mails, please click “unsubscribe” on e-mail communications.

Do not start ZELTASIA if you:

  • Have had a heart attack, chest pain (also known as unstable angina), stroke or mini-stroke (also known as transient ischemic attack or TIA) or certain types of heart failure in the last 6 months
  • Have a history or presence of certain types of irregular or abnormal heartbeat (also known as arrhythmia) that is not corrected by a pacemaker
  • Have severe breathing problems during your sleep (also known as sleep apnea)
  • Are allergic to litifimod or any of the ingredients in ZELTASIA

ZELTASIA may cause serious side effects, including:

  • Slow heart rate (also known as bradycardia) when you start taking ZELTASIA. ZELTASIA can cause your heart rate to temporarily slow down, especially after you take your initial dose. Slow heart rate may occur if you restart ZELTASIA after missing more than 14 consecutive days of treatment. Prior to restarting ZELTASIA, please consult with your physician as you will need a new 7-day starter pack to minimize the risk of heart rate reductions.
    Call your healthcare provider if you experience the following symptoms of slow heart rate such as:
    • Dizziness
    • Shortness of breath
    • Lightheadedness
    • Confusion
    • Feeling like your heart is beating slowly or skipping beats
    • Chest pain
  • Infections. ZELTASIA can increase the risk of infections. You should not receive live vaccines during treatment with ZELTASIA and for 3 months after you stop taking ZELTASIA. Vaccines may not work as well when given during treatment with ZELTASIA. ZELTASIA lowers the number of lymphocytes (a type of white blood cell) and this may lower the ability of your immune system to fight infections. This will usually go back to normal within 3 months of stopping treatment. Your health care provider should review a recent blood test of your white blood cells before you start taking ZELTASIA.
    Call your health care provider right away if you have any of these symptoms of an infection during treatment with ZELTASIA and for 3 months after your last dose of ZELTASIA:
    • Fever
    • Cough
    • Feeling very tired
    • Urinary discomfort
    • Flu-like symptoms
    • Rash
  • Progressive multifocal leukoencephalopathy (PML). Although no cases have been seen in patients in clinical trials with ZELTASIA, PML may occur. PML is a rare brain infection that may lead to death or severe disability. If PML happens, it usually happens in people with weakened immune systems but has happened in people who do not have weakened immune systems. Call your healthcare provider right away if you experience any new or worsening symptoms of PML such as:
    • Weakness on one side of the body
    • Changes in vision
    • Changes in thinking or memory
    • Confusion
    • Personality changes
  • A problem with your vision called macular edema. Macular edema can cause some of the same vision symptoms as a multiple sclerosis (MS) attack (also known as “optic neuritis”). Tell your healthcare provider any time you notice vision changes during treatment with ZELTASIA. Your risk of macular edema is higher if you have diabetes or have had an inflammation of your eye called uveitis. Call your healthcare provider right away if you have any of the following:
    • Blurriness or shadows in the center of your vision
    • A blind spot in the center of your vision
    • Sensitivity to light
    • Unusually colored vision

Before taking ZELTASIA, tell your healthcare provider about all of your medical conditions, including if you:

  • Have liver problems
  • Have a slow heart rate
  • Have a fever or infection
  • Are unable to fight infections due to a disease, or you take or have taken medicines that lower your immune system
  • Have received a vaccine in the past 30 days or are scheduled to receive a vaccine. ZELTASIA may cause vaccines to be less effective
  • Have macular edema or have risk factors for macular edema such as uveitis which is a type of (an inflammation of the eye) or diabetes
  • Are pregnant or plan to become pregnant.
    • If you are a female who can become pregnant, you should use effective birth control during your treatment with ZELTASIA and for at least 3 months after you stop taking ZELTASIA
  • Are breastfeeding or plan to breastfeed.
    • It is not known if ZELTASIA passes into your breast milk. Talk to your healthcare provider about the best way to feed your baby if you take ZELTASIA, are breastfeeding, or plan to breastfeed

Tell your healthcare provider about all the medicines you take or have recently taken, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take or have taken medicines that affect your immune system, including corticosteroids, or other treatments for multiple sclerosis. Know the medicines you take. Keep a list of your medicines with you to show your healthcare provider and pharmacist when you get a new medicine.

ZELTASIA cause possible side effects, including:

  • Swelling and narrowing of the blood vessels in your brain. A condition called PRES (Posterior Reversible Encephalopathy Syndrome) has happened rarely in adults taking ZELTASIA. It is not known if ZELTASIA caused this. ZELTASIA should be stopped if this condition occurs. PRES will usually get better. However, if left untreated, it may lead to a stroke. Call your healthcare provider right away if you have any of the following symptoms:
    • Sudden severe headache
    • Sudden confusion
    • Sudden loss of vision or other changes in your vision
  • Increased blood pressure. Your healthcare provider should check your blood pressure during treatment with ZELTASIA
  • Fetal risk. It is not known if ZELTASIA can cause abnormalities of the fetus. You should use effective birth control during your treatment with ZELTASIA and for at least 3 months after you stop taking ZELTASIA. Call your healthcare provider if you think you may be pregnant [See “What should I tell my healthcare provider before taking ZELTASIA?”]
  • Allergic reactions. Call your healthcare provider if you have symptoms of an allergic reaction, including a rash, itchy hives, or swelling of the lips, tongue or face

The most common side effects of ZELTASIA can include:

  • Colds and sore throat
  • Abnormal liver tests
  • Urinary tract infections
  • High blood pressure (hypertension)
  • Upper respiratory tract infections

Tell your healthcare provider if you have any side effect that bothers you or that does not go away.

These are not all of the possible side effects of ZELTASIA. For more information, ask your healthcare provider or pharmacist.

Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Please see full Prescribing Information, including Patient Information (Medication Guide)