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Patient Access Network Foundation (PAN)
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PO Box 221858
Charlotte, NC 28222
Phone
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(866)316-7263
Fax:
(866)316-7263
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Eligibility
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This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. |
| Who Can Apply
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Patients or healthcare providers can complete the application online or by phone. |
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Required
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Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received. |
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Supply
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Not applicable |
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Ship To
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Patient sent card to be used at pharmacy |
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Note
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*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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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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| Phoslyra oral solution |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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Phoslyra Patient Assistance Program
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1901 Eastpoint Parkway
Louisville, KY 40223
Phone
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(877)774-6756
Fax:
(866)496-8638
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Eligibility
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This program is intended for patients without prescription coverage. Medicare partD patients are eligible, but contact program for details. Income requirements are not disclosed. Must be a US citizen or legal resident. |
| Who Can Apply
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Call for application to be faxed or mailed or download application. Fax application back to company. Patient and Doctor will be notified in writing within 24-48hrs. |
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Required
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Must be on dialysis. Must have diagnosis of End Stage Renal Disease (ESRD). Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information. |
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Supply
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Up to 60 day supply. Patient and Doctor must contact company for refills. Refill limit not specified. Every 6 months or 12/31 of each year, whichever comes first, new application must be completed. |
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Ship To
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Shipped to Patients house within 7-10 business days. |
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Note
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This program also provides copay assistance. |
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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.
|
| Phoslyra oral solution |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Phoslyra Patient Assistance Program |
| (Requires Acrobat Reader)
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