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Biogen Idec Copay Assistance Program
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5000 Davis Drive
P.O. Box 13919
Morrisville, NC 27709
Phone
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(800)456-2255
Fax:
(877)301-5140
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Eligibility
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Patients must not have any public insurance or Medicare Part D. Patients that have private insurance may qualify for the program. All US residents may apply, excluding the state of MA. There are no income limits for this program. Patients must have a diagnosis of a relapsing form of MS. |
| Who Can Apply
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Applicants must call for a prescreening. There is no application for this program. |
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Required
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The physician must fax in a copy of the prescription. The applicant must provide information and proof of income. A decision will be made during the phone screening. |
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Supply
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For Avonex, up to a 90 day supply is provided. For Tysabri, a 30 day supply of the medication is provided. |
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Ship To
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Avonex will be shipped to the doctor's office or to the patient's home. Tysabri will be sent to the doctor's office or site of care for administration of the infusion. |
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Note
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For refills, the pharmacy will contact the patient. Insurance benefits, claim assistance and/or other reimbursement help is offered. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Avonex Injection |
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Diplomat's Co-Pay Assistance Navigator Program
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Attention FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507
Phone
:
(877)977-9118
Ext 89864
Fax:
(810)282-0176
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Eligibility
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Insurance determined case by case. Medicare Part D patients are eligible for this program. Income requirements determined case by case. Must be a US resident. Must have medically appropriate condition/diagnosis. |
| Who Can Apply
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Patient or Doctor may call to receive application via fax or mail. May also complete application online. Application is to be mailed or faxed back to company. |
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Required
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Doctor's action will be discussed with patient and Doctor after request is received. Patient must complete application, sign and provide annual income information. Proof of income may be requested by program at any time. Patient and/or Doctor are notified of decision within 1-2 business days. |
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Supply
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Amount requested is sent. Company contacts patient to arrange refills, refill limit varies. Re-applications are determined case by case. |
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Ship To
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Once approved medication is shipped to Patient's home within 2 business days. |
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Note
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Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Avonex Injection |
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The Free Drug Program
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5000 Davis Drive
P.O. Box 13919
Morrisville, NC 27709
Phone
:
(800)456-2255
Fax:
(877)301-5140
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Eligibility
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Patients must be uninsured or underinsured. Patients enrolled in Medicare Part D may be eligible. Patients must reside in the U.S. and have a relapsing form of MS. Income guidelines are not disclosed. |
| Who Can Apply
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Applicants must call for a prescreening. There is no application for this program. |
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Required
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Doctor's must fax in a copy of a prescription. The patient must provide information and proof of income. The decision will be made during the phone screening. |
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Supply
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For Avonex: up to a 90-day supply of the medication is sent. For Tysabri: a one month supply is sent. |
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Ship To
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Avonex will be shipped to the doctor's office or the patient's home. Tysabri will be sent to the doctor's office or site of care for administration of the infusion. |
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Note
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The company will contact the patient to arrange refills and also regarding the re-application procedure. Insurance benefits, claims assistance and/or other reimbursement help is offered. |
| |
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Avonex Injection |
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