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RaptorCares
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Phone
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855-888-4004
Fax:
877-773-9411
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Eligibility
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Patients with insurance, including Medicare Part D, may apply. Income requirements for this program have not been disclosed. Patients must have a medically appropriate condition/diagnosis and must be a US resident. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
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Required
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Doctors must complete a section and sign. Patients must also complete a section, sign and attach insurance information. |
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Supply
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Varies |
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Ship To
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Patient's home, unless otherwise noted |
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Note
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This program also provides copay assistance. |
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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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| Procysbi capsule; delayed release |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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