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Patient Assistance Information

 
11 Programs Sponsored By Novartis Pharmaceuticals Corporation (External Link)
 
 
Exjade Patient Assistance and Support Services (EPASS)


,
Phone : 888-903-7277 Ext OPT 2
Fax: 888-891-4924
Eligibility
> This program is intended for patients that have no prescription coverage. Patients with Medicare Part D will be considered on a an exception basis. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> The patient or doctor should call the above phone number and select the appropriate prompt for the medication to obtain additional information and next steps.
Required
>
Supply
> Up to a 30-day supply
Ship To
> Patient's home
Note
>
 
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.
 
Exjade (deferasirox)
 
 
 
Cosentyx Connect Personal Support Program


,
Phone : (844)267-3689
Fax: (844)666-1366
Eligibility
> This program provides brand name medications at no or low cost. Insurance status will be covered on a case by case basis. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must have an FDA-approved diagnosis and be a US resident.
Who Can Apply
> Doctors or Patients can obtain an application by calling and having one faxed to them.
Required
> Doctors must complete and sign a section of the application. Patients must complete, sign and attach required documents. The application can then be faxed or mailed.
Supply
> Varies
Ship To
> Not specified
Note
> Eligibility determined on a case-by-case basis. Contact program for more details on copay assistance, the sharps container mail-back program and injection training.
 
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.
 
Cosentyx injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader
 
 
Tobi Patient Support Program

TOBI Patient Support Program
250 Technology Park
Lake Mary, FL 32746
Phone : (866) 598-8624
Fax:
Eligibility
> Patients 6 years of age and older who have Cystic Fibrosis, meet the program's income guidelines and have no access to health insurance benefits. Patients must be permanent US residents.
Who Can Apply
> Physician's office must call on patient's behalf.
Required
> Income and insurance information required along with a signed application and a legal prescription.
Supply
> 1 box (28-day supply)
Ship To
> Cystic Fibrosis Pharmacy mails one box of medication to patient's home.
Note
> Completely new application must be filed every 6 months.
 
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.
 
Tobi (tobramycin)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader
 
 
TOBI Patient Assistance Program

PO Box 66978
St. Louis, MO 63166-6978
Phone : 877-862-4423
Fax:
Eligibility
> The patient must not have prescription drug coverage (public or private) and must meet income eligibility criteria which vary by household size. The patient must also be a US resident.
Who Can Apply
> The patient or doctor should call the above phone number and select the appropriate prompt for the medication to obtain additional information and next steps.
Required
>
Supply
> Up to a 30-day supply
Ship To
> Patient's home
Note
> The patient or doctor should call the above phone number and select the appropriate prompt for the medication to obtain additional information and next steps.
 
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.
 
Depocyt (cytarabine liposome)
Proleukin (aldesleukin for injection)
Tobi (tobramycin)
 
 
 
Cosentyx Sharps Mail-Back Program


,
Phone : (844)267-3689
Fax:
Eligibility
> Patients must reside in the US to be eligible.
Who Can Apply
> Anyone interested can call to apply.
Required
> Patients must call to enroll.
Supply
> 1 kit
Ship To
>
Note
>
 
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.
 
Cosentyx Container disposal container
 
 
 
Entresto Central Patient Support Program


,
Phone : (888)368-7378
Fax:
Eligibility
> This program provides brand name medications at no or low cost. Insurance status requirements have not been disclosed for this program. Income requirements have not been disclosed. Patients must be a US resident.
Who Can Apply
> Patients or doctors can call to have an applicaion faxed or download the application.
Required
> Doctor's must complete a section, sign, and attach required documents. Patients must complete a section, sign, and attach required documents. The application must then be faxed from the doctor's office.
Supply
> Not specified
Ship To
> Not specified
Note
> This program also provides copay assistance. Contact program to obtain information on Entresto or to request free samples.
 
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.
 
Entresto tablet
 
 
 
Extavia Go Program

Customer Interaction CenterNovartis
Pharmaceuticals Corporation
East Hanover, NJ 07936
Phone : (866)925-2333
Fax:
Eligibility
> This program provides brand name medications at no or low cost. Patient insurance status will be considered on a case by case basis. Patients with Medicare Part D will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must have an FDA-approved diagnosis and be a US resident.
Who Can Apply
> Patients or doctors can call to have an application faxed or mailed.
Required
> Doctors must complete and sign a section of the application. Patients also complete a section of the application, sign, attach proof of income and attach any insurance information. The application can then be faxed or mailed.
Supply
> Varies
Ship To
> Card obtained from doctor's office
Note
> Eligibility determined on a case-by-case basis.
 
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.
 
Extavia injection
 
 
 
GILENYA Go Program

Customer Interaction CenterNovartis
Pharmaceuticals Corporation
East Hanover, NJ 07936
Phone : (800)445-3692
Fax: (877)428-5889
Eligibility
> This program provides brand name medications at no or low cost to patients. Patients, including Medicare Part D recipients, are eligible. Income requirements for this program have not been disclosed. Patients must have an FDA-approved diagnosis and be a US resident.
Who Can Apply
> Patients or doctors can call or download an application.
Required
> Doctors must complete and sign a section of the application. Patients must complete and sign a section of the application and attach insurance information. The application can then be faxed.
Supply
> Varies
Ship To
> Varies
Note
> Eligibility determined on a case-by-case basis.
 
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.
 
Gilenya capsule
 
 
 
Ilaris Patient Support Program


,
Phone : 866-972-8315
Fax: 855-817-2711
Eligibility
> This program provides brand name medications at no or low cost. Insurance status requirements will be considered on a case by case basis. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have bot been disclosed. Patients must have an FDA-approved diagnosis and be a US resident.
Who Can Apply
> Patients or doctors can call to obtain an application.
Required
> Doctors must complete and sign a portion of the application. Patients must complete a portion of the application, sign, attach proof of income and attach any insurance information.
Supply
> Varies
Ship To
> Card obtained from doctor's office
Note
> Eligibility determined on a case-by-case basis.
 
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.
 
Ilaris injection; subcutaneous
 
 
 
Novartis Oncology Patient Assistance Program

PO Box 52029
Phoenix, AZ 85072
Phone : 866-884-5906
Fax: 888-891-4924
Eligibility
> This program provides brand name medications at no or low cost to patients that have no prescription coverage. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> Doctors must ask for service request and have the application faxed or mailed to them.
Required
> Doctors must complete a portion of the application, sign and attach a prescription. Patients must complete a portion of the application, sign and attach proof of income and any insurance information.
Supply
> Not specified
Ship To
> Doctor's office or patient's home
Note
> Eligibility determined on a case-by-case basis. Uninsured patients, call 1-866-884-5906 Patients with insurance, call 1-800-282-7630 This program also provides copay assistance up to $36,000 per year for Signifor and $9,600 per year for Sandostatin. Carcinoid tumor patients are now eligible.
 
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.
 
Afinitor Disperz tablet
Afinitor tablet
Arranon Injection
Arzerra injection
Farydak capsule
Gleevec tablet
Hycamtin capsule
Hycamtin Injection
Jadenu
Mekinist tablet
Odomzo capsule
Promacta
Sandostatin LAR injection
Signifor
Signifor LAR
Tafinlar capsule
Tasigna capsule
Tykerb
Votrient tablet
Zometa
Zykadia capsule
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader
 
 
Novartis Patient Assistance Foundation, Inc.

PO Box 52029
Phoenix, AZ 85072
Phone : 800-277-2254
Fax: 855-817-2711
Eligibility
> This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors must complete a portion of the application, sign and attach a prescription for 90 days. Patients must complete a portion of the application, sign and attach a copy of proof of income.
Supply
> Varies
Ship To
> Doctor's office or patient is sent card to be used at pharmacy.
Note
> For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician.
 
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.
 
Arcapta Neohaler powder; inhalation
Coartem tablet
Entresto tablet
Focalin XR capsule; extended release
Glatopa injection
Lamisil granule; oral
Myfortic tablet; delayed release
Neoral
Omnitrope injection
Reclast injectable; iv (infusion)
Sandimmune
Tegretol
Tegretol XR tablet; extended release
Tekturna HCT tablet
Tekturna tablet
Tobi Podhaler powder; inhalation
Tobi solution; inhalation
Trileptal tablet
Tyzeka tablet
Zortress tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
(Requires Acrobat Reader