| |
Sunovion Support Prescription Assistance Program
|
PO Box 220285
Charlotte, NC 28222
Phone
:
(877)850-0819
Fax:
(877)850-0821
|
|
Eligibility
|
| > |
The patient must be a resident of the United States, Puerto Rico, or the US Virgin Islands, and be 18 years of age or older. They must not have prescription coverage (this includes Medicare and Medicaid). The patient must have a household annual income at or below 300% of the Federal Poverty Level. |
| Who Can Apply
|
| > |
The patient can obtain an application by mail or by download. It must be returned via mail or faxed. |
|
Required
|
| > |
The patient must complete and sign a portion of the application and attach proof of income. The physician must also complete and sign a portion of the application. A decision will be made within 48 hours and the patient will receive notification in writing. |
|
Supply
|
| > |
Up to 90 day supply |
|
Ship To
|
| > |
The medication will be sent to the physician's office or a card is sent to the patient's address to be used at the pharmacy. |
|
Note
|
| > |
The patient must complete a new application yearly. |
| |
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.
| | Latuda Tablet |
| |
| |
|
|
| |
Sunovion ProFile (FOR HEALTHCARE PROFESSIONAL ONLY)
|
84 Waterford Drive
Marlborough, MA 01752
Phone
:
888-394-7377
Fax:
|
|
Eligibility
|
| > |
Patients must meet income requirements that have not been disclosed, have a medically appropriate diagnosis/condition and be treated by a US doctor. |
| Who Can Apply
|
| > |
Not specified |
|
Required
|
| > |
Patients must inform their doctor that they are in need. Doctors must determine if the patient is truly in need. |
|
Supply
|
| > |
Not specified |
|
Ship To
|
| > |
Not specified |
|
Note
|
| > |
HEALTHCARE PROFESSIONAL MUST REGISTER. |
| |
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.
| | Alvesco aerosol; inhalation | | Aptiom tablet | | Brovana solution; inhalation | | Latuda Tablet | | Lunesta tablet | | Omnaris spray; nasal | | Xopenex HFA aerosol; inhalation | | Zetonna aerosol; nasal |
| |
| |
|
|
| |
Sunovion Support Prescription Assistance Program (Aptiom)
|
PO Box 220285
Charlotte, NC 28222
Phone
:
(877)850-0819
Fax:
877-850-0821
|
|
Eligibility
|
| > |
Patients must have no prescription coverage for the needed medication, be at or below 300% of the Federal Poverty Level, must reside in the US, Puerto Rico or USVI and must provide a diagnosis code. |
| Who Can Apply
|
| > |
Patients or healthcare providers can call to have an application mailed or it can be downloaded. |
|
Required
|
| > |
Doctors must complete a section of the application and sign. Patients must also complete a section of the application, sign and attach proof of income. |
|
Supply
|
| > |
30 day supply |
|
Ship To
|
| > |
Pharmacy |
|
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.
| | Aptiom tablet |
| |
| |
|
|
|