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Daraprim Direct Program
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Phone
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844-267-3323
Fax:
877-241-1365
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Eligibility
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Insurance status will be considered on a case by case basis. Patients must meet income requirements that have not been disclosed and have a medically appropriate condition/diagnosis. |
| Who Can Apply
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Doctors can call for an application or download one. |
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Required
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Patients must inform the doctor that they are in need. Doctors must complete a section of the application, sign and attach required documents. |
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Supply
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Not specified |
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Ship To
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Not specified |
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Note
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Resources for HEALTHCARE PROFESSIONALS ONLY.
This program provides delivery, reimbursement and support services. |
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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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| Daraprim Tablets |
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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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