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Patient Assistance Information

 
1 Program for Intron-A Injection
 
 
Commitment to Care for Hepatitis C Medications

PO Box 18725
Louisville, KY 40261
Phone : 800-521-7157 Ext OPT 2
Fax: 800-683-7855
Eligibility
> The patient cannot have prescription insurance, be ineligible for any federal or state programs and meet income guidelines that are not disclosed.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The patient must fill out a section, sign the application and attach proof of income and any insurance information.
Supply
> Up to a 30-day supply
Ship To
> Either Doctor's office or Patient's home
Note
> With the patient's permission, anyone concerned can call for an application.
 
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.
 
Intron-A Injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader