Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
Program Sponsored By Good Days from CDF (External Link)
 
 
Good Days Program

6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone : (877)968-7233
Fax: (214)570-3621
Eligibility
> Insurance requirements not specified, this includes Medicare PartD. Income requirements for this program have not been disclosed. US residency requirements not specified.
Who Can Apply
> Call to have application faxed, mailed, download from website or apply online. Return application via fax, mail or submit online. Patient and/or Doctor are notified of decision.
Required
> Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents.
Supply
> Refill process and limit not specified. Must re-enroll at the end of every calendar year.
Ship To
> Shipping location not specified.
Note
> Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
 
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.
 
Abraxane injection
Actimmune
Adcetris
Adcirca tablet
Afinitor
Agrylin
Alimta
Arimidex
Aromasin
Aubagio
Avastin
Avonex
Bactrim
Baraclude
Betaseron
Buphenyl
Camptosar
Caprelsa
Cimzia
Clolar
Cometriq
Copaxone
Cotellic
Cystagon
Cystaran ophthalmic solution
Cytoxan
Dacogen
Daklinza
Darzalex
Desferal
Docefrez
Eloxatin
Entocort EC
Epivir
Erbitux
Exjade
Extavia
Eylea
Fareston
Faslodex
Ferriprox
Flolan injection
Gemzar
Genotropin
Gilenya
Gilotrif
Glatopa injection
Gleevec
Halaven
Harvoni
Hepsera
Herceptin
Humatrope
Humira
Ibrance
Iclusig
Iluvien implant
Incivek
Increlex injection
Infergen
Intron A
Isordil
Ixempra
Jadenu
Jakafi
Jetrea injection
Kadcyla
Keytruda
Lemtrada
Letairis tablet
Lonsurf
Lucentis
Macugen
Matulane
Mekinist
Moderiba tablet
Nascobal spray; nasal
Navelbine
Nexavar
Norditropin
Nutropin
Olysio
Omnitrope
Onmel
Opdivo
Opsumit tablet
Orenitram tablet; extended release
Pegasys
PegIntron
Perjeta
Pomalyst
Prednisolone oral solution
Procysbi capsule; delayed release
Proleukin
Provenge
Ravicti liquid
Rebetol
Rebif
Remicade
Remodulin injection
Revatio
Revlimid
Ribasphere
Roferon-A
Saizen
Serostim
Signifor
Soltamox
Sovaldi
Sporanox
Sprycel
Stivarga
Sutent
Synribo
Tafinlar
Tagrisso tablet
Tarceva
Tasigna
Taxol
Taxotere
Tecfidera capsule; delayed release
Tev-Tropin
Thalomid
Tracleer tablet
Tykerb
Tysabri
Tyvaso solution; inhalation
Tyzeka
Valtropin
Vectibix
Velcade
Veletri injection
Ventavis solution; inhalation
Victrelis
Vidaza
Viekira Pak
Viread
Visudyne
Xalkori
Xeloda
Xofigo
Xolair
Xtandi
Yervoy
Zaltrap
Zanosar
Zelboraf
Zorbtive
Zortress
Zykadia
Zytiga
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader