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Cystatdane Patient Assistance Program
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C/O NORD
PO Box 1968
Danbury, CT 06813-1968
Phone
:
800-999-6673
Fax:
203.798.2291
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient is given assistance from 25%-100% for one year. A negative decision can be appealed.The patient must also be a US resident. |
| Who Can Apply
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Anyone with the patient's and the doctor's information can call. |
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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, sign the application and attach proof of income. |
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Supply
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Up to a 90-day supply |
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Ship To
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Patient's home |
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Note
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Anyone with the patient's and the doctor's information can call. |
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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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| Cystadane |
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Xyrem Patient Assistance Program
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Xyrem Patient Assistance Program
C/O NORD
Danbury, CT 06813-1968
Phone
:
866-997-3688
Fax:
203-798-2964
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Eligibility
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The patient must have no prescription coverage for the requested medication and meet income guidelines that are not disclosed. The patient must also be a US resident or legal alien. |
| Who Can Apply
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The doctor/doctor's office must call for a prescreening. |
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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, sign the application and attach proof of income and any insurance information. |
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Supply
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| > |
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Ship To
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| > |
Patient's home |
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Note
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| > |
The doctor/doctor's office must call for a prescreening. |
| |
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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| Xyrem |
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