eHIPAA
Info form
Authorization
Review
Questions?
Call the Cayston Access Program
1-877-7CAYSTON
1-877-722-9786
Hours of Operation
(Monday–Friday 8AM – 8PM EST)

Cayston, the Cayston Access
Program and the Cayston logo are
trademarks of Gilead Sciences, Inc.
ADMC0396 12/18

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About This Form

The Cayston Access Program is a patient support program designed to provide information about your CAYSTON® (aztreonam for inhalation solution) coverage, triages to Specialty Pharmacy for fulfillment, and other support offerings. The Cayston Access Program is an agent of Gilead Sciences, Inc. In order to provide financial assistance and information, Gilead Sciences will need to use your health information (called “Protected Health Information” or “PHI”), and to share it with your health plan and the pharmacy that will receive your doctor’s prescription. This authorization will allow your health care providers, and health insurers that maintain PHI about you to disclose your PHI to Gilead Sciences, Inc. and its contractors and agents so that the Support Center may provide financial assistance and information to you, or on your behalf.

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