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Patient Assistance Information

 
Program Sponsored By R-Pharm US (External Link)
 
 
R-Pharm US Access and Support Program

c/o Sonexus Health
2730 S. Edmonds Lane Suite 300
Lewisville, TX 75067
Phone : 855-991-7277
Fax: 877-541-7813
Eligibility
> Patients must be uninsured, at or below 300% of the Federal Poverty Level, have an FDA-approved diagnosis and be a US citizen.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed.
Required
> Doctor and patient must each complete a section and sign. The application can be returned by fax.
Supply
> Not specified
Ship To
> Not specified
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.
 
Ixempra
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader