Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
Program Sponsored By Fresenius Medical Care North America (External Link)
 
 
Venofer Patient Assistance Program (for Free Standing Dialysis Clinics only)

1901 Eastpoint Parkway
Louisville, KY 40223
Phone : (877)694-7661
Fax: (866)496-8638
Eligibility
> This program is intended for Patients with no prescription coverage. Medicare partD not eligible. Income requirements not disclosed. Must be a US resident or legal entrant.
Who Can Apply
> Clinic must call for application to be faxed or download. Return application via fax or mail. Clinic will be notified in writing within 24-48hrs of decision.
Required
> Diagnosis/medical criteria required: End Stage Renal Disease (585.6) and be on dialysis. Doctor must complete and sign application. Patient must complete application sign and attach proof of income.
Supply
> Amount/supply varies. Refill process not applicable. Refill limit not specified. New application must be completed every 12 months.
Ship To
> Ships to clinic in 1-3 business days.
Note
> After PAP application approval the provider must return the Venofer product order form for replacement product. Contact program for Spanish application.
 
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.
 
Venofer injection