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Sanofi Patient Connection
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PO Box 222138
Charlotte, NC 28222
Phone
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(888)847-4877
Fax:
(888)847-1797
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Eligibility
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An application must be submitted for each patient. They can be submitted via fax, or mail. The patient must be a US citizen or resident, with a Social Security Number. The patient must be under the care of a licensed healthcare provider who is authorized to prescribe, dispense and administer medicine in the US. The patient must have an income at or below 500% of the FPL for oncology and hematology products and at or below 250% for all other products. For Vaccines, patient must be 19 years of age or older (except IMOVAX RABIES and IMOGAM RABIES HT). |
| Who Can Apply
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Anyone requesting assistance may call to request an application. |
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Required
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The application must be completed and signed by both the patient and by the healthcare provider. Proof of income must also be submitted which includes a copy of the most recently filed US Income Tax Return, a copy of a W-2, or most recent Social Security statement. |
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Supply
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A 30 to 90 day supply will be sent, depending on the medication. |
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Ship To
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The medication will be shipped to the doctor's office. |
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Note
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For refills, a reorder form must be faxed to Sanofi Patient Connection. A new application is required once a year. |
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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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| Thymoglobulin [Anti-thymocyte Globulin (Rabbit)] |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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