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Actimune Patient Assistance Program
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PO Box 4280
Gaithersburg, MD 20885
Phone
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800-577-9112
Ext 1
Fax:
240-632-3873
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Eligibility
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This program is based on guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis. |
| Who Can Apply
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The doctor, patient, social worker or patient advocate must 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 copy of the DEA or State License number.The patient must fill out a section, sign the application and attach proof of income. |
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Supply
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A 90-day supply |
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Ship To
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Hospital, Doctor's office or Pharmacy |
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Note
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The doctor, patient, social worker or patient advocate must 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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| Actimmune Injection |
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