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Zevalin Results
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PO Box 222007
Charlotte, NC 28222-2007
Phone
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800-386-9997
Fax:
800-513-8095
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Eligibility
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This program is based on guidelines that are not disclosed. The patient must also be a US resident. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section and sign the application. |
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Supply
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The medication is sent one treatment cycle at a time |
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Ship To
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Doctor's office |
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Note
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With the patient's permission, anyone concerned can call for an application. |
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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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| Yttrium-90 Zevalin Kit |
| Zevalin Kit-Indium-111 |
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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 Application Form |
(Requires Acrobat Reader) 
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Biogen Idec Copay Assistance 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 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 (interferon beta-1a) |
| Avonex Injection |
| Tysabri IV Infusion (natalizumab) |
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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. |
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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.
|
| Avonex (interferon beta-1a) |
| Avonex Injection |
| Tysabri IV Infusion (natalizumab) |
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