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Transplant Medical Needs Program
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14042 B Riverport Dr
Maryland Heights, MO 63043
Phone
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(800) 772-5790
Fax:
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Eligibility
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Eligibility is based on income and lack of insurance |
| Who Can Apply
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Physician's office |
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Required
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Original application and prescription are required. |
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Supply
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Ship To
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Physician's office and Patients home |
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Note
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Roche Oncoline Patient Assistance Program
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P.O. Box 18647
Louisville, KY 40261
Phone
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(888)249-4918
Fax:
(888)249-4919
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Eligibility
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The patient must have no prescription coverage, have reached his/her cap or cannot afford the co-payments and meet income guidelines that are not disclosed. |
| Who Can Apply
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The doctor, patient, social worker or patient advocate must call for a prescreening. |
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Required
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The doctor must fill out a section, sign the application and attach a prescription for 90 days.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Up to a 90-day supply is sent to the doctor's office or the patient's home. |
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Ship To
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Either Doctor's office or Patient's home |
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Note
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The doctor, patient, social worker or patient advocate must call for a prescreening. |
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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.
| | Kytril Injection | | Kytril Oral Solution | | Kytril Tablets | | Roferon A Injection | | Roferon-A Injection | | Vesanoid Tablets | | Xeloda Tablets |
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Roche Reimbursement and PAP for HCV, HIV and Transplants
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PO Box 66763
St. Louis, MO 63166-6763
Phone
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866-247-5084
Fax:
800-305-1830
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Eligibility
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The patient must meet insurance guidelines that are not disclosed and have an income at or below 300% of the Federal Poverty Level. The patient must also be a US resident. |
| Who Can Apply
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The patient or doctor needs to call for a prescreening. |
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Required
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The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Ship To
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Either Doctor's office or Patient's home |
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Note
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The patient or doctor needs to call for a prescreening. |
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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.
| | Cellcept Oral Solution | | Cellcept Tablets | | Copegus Tablets | | Fuzeon T-20 Injection | | Invirase Capsules | | Invirase Tablets | | Pegasys Injection | | Valcyte Tablets | | Zenapax Injection |
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PegAssist Program
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14042 B Riverport Dr
Maryland Heights, MO 63043
Phone
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(866) 247-5084
Fax:
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Eligibility
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Eligibility is based on patient's income and lack of third party precription coverage. |
| Who Can Apply
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Anyone may call to initiate application process. |
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Required
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Patient's proof of income is required as well as an original prescription. |
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Supply
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30 days. |
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Ship To
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Physician's office or Patients Home |
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Note
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A prescreening is done on initial phone call. If qualified, an application is sent to the physician's office for completion. The application, patient's proof of income and an original, legal prescription must be mailed in order for the patient to continue to receive medication. |
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