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Patient Assistance Information

 
Program Sponsored By Kowa Pharmaceuticals America, Inc. (External Link)
 
 
KPAssist Patient Assistance Program

Attn Truax Patient Services
602 Beltrami Ave. NWSuite 105
Bemidji, MN 56601
Phone : (877)438-9759
Fax: (877)438-9759
Eligibility
> The KPAssist Patient Assistance Program provides brand name medications at no or low cost and is intended for patients that have no prescription coverage for the needed medication. Patients with Medicare Part D are eligible if the medication is not covered. Patients must be at or below 150% of the Federal Poverty Level. They must also be a US citizen or legal entrant.
Who Can Apply
> Patients can call to receive an application and it can be emailed, faxed or mailed to them.
Required
> Patients and doctors must complete and sign the application and attach proof of income and insurance company denial letters.
Supply
> Up to 3 months supply
Ship To
> Patient's home.
Note
> This program also provides copay assistance.
 
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader