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Sun Pharmaceutical Imatinib Patient Assistance Program
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Phone
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844-502-5950
Fax:
866-810-3258
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Eligibility
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Patients must have no prescription coverage for the needed medication. Medicare Part D recipients are not eligible. Patients must be at or below 500% of the Federal Poverty Level or have experienced a recent financial challenge (supporting documentation required). They must also have an FDA-approved diagnosis and be a US resident, have a green card or work visa. |
| 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 and patients must each complete a section, sign the application and attach required documents. |
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Supply
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30 day supply |
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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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*If a patient qualifies, they may receive free medication monthly through July 2016
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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| imatinib tablet |
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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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