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PegAssist Program
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14042 B Riverport Dr
Maryland Heights, MO 63043
Phone
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(866) 247-5084
Fax:
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Eligibility
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Eligibility is based on patient's income and lack of third party precription coverage. |
| Who Can Apply
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Anyone may call to initiate application process. |
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Required
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Patient's proof of income is required as well as an original prescription. |
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Supply
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30 days. |
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Ship To
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Physician's office or Patients Home |
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Note
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A prescreening is done on initial phone call. If qualified, an application is sent to the physician's office for completion. The application, patient's proof of income and an original, legal prescription must be mailed in order for the patient to continue to receive medication. |
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Roche Reimbursement and PAP for HCV, HIV and Transplants
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PO Box 66763
St. Louis, MO 63166-6763
Phone
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866-247-5084
Fax:
800-305-1830
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Eligibility
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The patient must meet insurance guidelines that are not disclosed and have an income at or below 300% of the Federal Poverty Level. The patient must also be a US resident. |
| Who Can Apply
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The patient or doctor needs to call for a prescreening. |
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Required
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The doctor must fill out a section, sign the application and attach a prescription.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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Ship To
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Either Doctor's office or Patient's home |
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Note
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The patient or doctor needs to call for a prescreening. |
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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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| Copegus Tablets |
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