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Good Days Program
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6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone
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(877)968-7233
Fax:
(214)570-3621
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Eligibility
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Insurance requirements not specified, this includes Medicare PartD. Income requirements for this program have not been disclosed. US residency requirements not specified. |
| Who Can Apply
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Call to have application faxed, mailed, download from website or apply online. Return application via fax, mail or submit online. Patient and/or Doctor are notified of decision. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents. |
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Supply
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Refill process and limit not specified. Must re-enroll at the end of every calendar year. |
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Ship To
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Shipping location not specified. |
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Note
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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. |
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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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| Nascobal spray; nasal |
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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 Good Days Program |
(Requires Acrobat Reader) 
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Nascobal Patient Assistance Program
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1267 Professional Parkway
Gainsville, GA 30507
Phone
:
(800)589-0841
Fax:
(855)828-1491
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Eligibility
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This program is intended for Patients with no prescription insurance coverage, this includes Medicare partD patients. Income must be at or below 200% of FPL and a US resident. Diagnosis/medical criteria not specified. |
| Who Can Apply
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Call for fax or mailed application or download from website. Application must be returned from the prescriber's office via fax or mail. Decision will be communicated within 2-3 days. |
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Required
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Doctor must complete and sign application. Patient must complete application, sign and attach required documents. |
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Supply
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Amount/supply varies. Copy of application with new signatures and new prescription required for refills. Refill limit not specified. Company contacts patient about reapplying after 6 months. |
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Ship To
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Medication ships to Doctor's office within 2 days. |
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Note
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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.
|
| Nascobal spray; nasal |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Nascobal Patient Assistance Program |
| (Requires Acrobat Reader)
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