|
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 |
|
|
|