| |
Pathways 360
|
,
Phone
:
(888)452-5248
Fax:
(888)806-4829
|
|
Eligibility
|
| > |
This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Must have FDA-approved diagnosis. |
| Who Can Apply
|
| > |
Call to have application faxed or download from the website. Application is to be faxed back to company. |
|
Required
|
| > |
Must be treated by US licensed healthcare provider and use a US pharmacy. Doctor must complete application, sign, and attach required documents. |
|
Supply
|
| > |
Amount not specified. Refill process & limit not specified. Re-application process not specified. |
|
Ship To
|
| > |
Shipping location and delivery time not specified. |
|
Note
|
| > |
Insurance benefits, claims assistance, and/or other reimbursement help is offered. |
| |
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.
|
| Kalbitor injection |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form Pathways 360 |
(Requires Acrobat Reader) 
|
| |
|
|