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Patient Assistance Information

 
Program Sponsored By Diplomat Specialty Pharmacy (External Link)
 
 
Diplomat's Co-Pay Assistance Navigator Program

Attention FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507
Phone : (877)977-9118 Ext 89864
Fax: (810)282-0176
Eligibility
> Insurance determined case by case. Medicare Part D patients are eligible for this program. Income requirements determined case by case. Must be a US resident. Must have medically appropriate condition/diagnosis.
Who Can Apply
> Patient or Doctor may call to receive application via fax or mail. May also complete application online. Application is to be mailed or faxed back to company.
Required
> Doctor's action will be discussed with patient and Doctor after request is received. Patient must complete application, sign and provide annual income information. Proof of income may be requested by program at any time. Patient and/or Doctor are notified of decision within 1-2 business days.
Supply
> Amount requested is sent. Company contacts patient to arrange refills, refill limit varies. Re-applications are determined case by case.
Ship To
> Once approved medication is shipped to Patient's home within 2 business days.
Note
> Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie
 
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.
 
Actemra injection
Afinitor tablet
Alimta injection
Alkeran tablet
Ampyra tablet; extended release
Aranesp vial
Arimidex tablet
Aubagio tablet
Avonex Injection
Betaseron vial
Bethkis solution; inhalation
Boniva injectable; iv
Boniva tablet
Bosulif tablet
Cabometyx
Caphosol Oral Solution
Casodex tablet
Cimzia injection
Cometriq capsule
Copaxone syringe; prefilled
Cotellic
Cuvposa oral solution
Dacogen injection
Daklinza
Eligard injection
Emend capsule
Entyvio
Epogen injection
Erbitux
Erivedge capsule
Esbriet capsule
Exjade tablet
Farydak capsule
Faslodex Injection
Femara tablet
Firazyr injection
Forteo injectable; subcutaneous
Fuzeon injectable; subcutaneous
Gazyva injection
Genotropin injection
Genotropin MiniQuick syringe; prefilled
Gilenya
Gleevec tablet
Harvoni tablet
Herceptin vial; iv
Hetlioz
Humatrope injection
Humira Injection
Hycamtin capsule
Ibrance capsule
Iclusig tablet
Imbruvica capsule
Infergen vial
Inlyta tablet
Intron A vial
Iressa
Jadenu
Jakafi tablet
Kadcyla vial; single-use
Kalydeco tablet
Keveyis tablet
Kitabis Pak inhalation solution
Lonsurf
Lupron Depot injection
Mekinist tablet
Neupogen syringe
Neupogen vial
Nexavar tablet
Nilandron
Ninlaro
Nplate injectable; subcutaneous
Nucala
Nutropin cartridge
Olysio capsule
Orencia injectable; iv (infusion)
Orkambi tablet
Otezla tablet
Pegasys syringe
PegIntron vial
Pomalyst capsule
Praluent
Prialt injectable; intrathecal
Procrit vial
Prolia injectable; subcutaneous
Promacta
Rebif syringe; subcutaneous
Remicade
Revlimid capsule
Ribasphere capsule
Ribasphere RibaPak capsule
Sancuso transdermal patch
Serostim injection
Simponi
Simponi Aria
Soltamox solution
Somatuline Depot injection
Sovaldi tablet
Sprycel tablet
Stelara injection
Stivarga tablet
Sutent Capsule
Sylatron vial
Synagis injection
Synribo powder; subcutaneous
Tafinlar capsule
Tagrisso tablet
Tarceva tablet
Targretin capsule
TARGRETIN® (bexarotene) Gel
Tasigna capsule
Tecfidera capsule; delayed release
Temodar capsule
Thalomid capsule
Thyrogen injection
Tobi Podhaler powder; inhalation
Tobi solution; inhalation
Trelstar injectable; intramuscular
Tykerb tablet
Tyzeka tablet
Velcade injectable; subcutaneous
Venofer injection
Victrelis capsule
Vidaza injectable; subcutaneous
Votrient tablet
Xalkori capsule
Xeljanz tablet
Xeloda tablet
Xtandi capsule
Zelboraf
Zelboraf tablet
Zepatier
Zofran tablet
Zoladex Implant
Zolinza capsule
Zometa injection
Zorbtive injection
Zydelig tablet
Zykadia capsule
Zytiga tablet