Sample Request Form

Medical Inquiry

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Healthcare professionals who have questions about Tirosint® can send their written requests for clinical information to:
Or call 1-888-383-1733

Please allow 3-4 weeks for response.

Save On Tirosint

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You can save money on your Tirosint® prescriptions the following ways:

Tirosint® Discount Cards

You can save money on your Tirosint® therapy each time that you go to the pharmacy by using the Tirosint® Discount Card. Simply present your card to receive instant savings. You can get your Tirosint® Discount Card from your physician or by clicking here for a printable version.

Patient Assistance Program (PAP)

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Eligible patients receive Tirosint® free for up to 1 year

Akrimax offers a patient assistance program (PAP) that provides Tirosint® to individuals who meet eligibility requirements. Eligibility is based on your patient’s annual household income and prescription insurance status. Patients must complete and return the enrollment form for eligibility determination.

Eligible patients will be automatically mailed their first month’s supply. They will then receive Tirosint® for free for up to 1 year by calling to refill their prescription every month. Patients must re-enroll each year to remain in the program.

For more information, patients may call (833) 838-3247

Click here to learn more.

Contact Sales Rep

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You can email an IBSA Pharma Inc. rep at