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Patient Assistance Information

 
Program Sponsored By Retrophin, Inc. (External Link)
 
 
Thiola Total Care Hub Program


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Phone : 844-484-4652
Fax: 877-473-3167
Eligibility
> Insurance eligibility will be considered on a case by case basis. Income and residency requirements for this program have not been disclosed. The medication must be medically necessary as determined by a doctor.
Who Can Apply
> Patients or healthcare providers can download the application.
Required
> Doctors must complete a section, sign, and attach required documents. Providers must complete a section, sign, and attach required documents. The application must be faxed from the doctor's office.
Supply
> Varies
Ship To
> Doctor's office or patient's home
Note
> Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.
 
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.
 
Thiola (tiopronin)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader