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Patient Assistance Information

 
2 Programs for Increlex injection
 
 
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.
 
Increlex injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader
 
 
Ipsen Cares Patient Assistance Program

120 Wesrton Oaks Court
Cary, NC 27513
Phone : 866-435-5677
Fax: 888-525-2416
Eligibility
> The Ipsen Cares Patient Assistance Program provides brand name medications at no or low cost and is intended for patients that have no prescription coverage for the needed medication. Medicare Part D patients are not eligible. No residency requirements have been specified. Patient must be diagnosed with severe Primary IGFD.
Who Can Apply
> Patients or doctors can call or print the applications below.
Required
> Application must be completed and signed by the doctor and the patient. Required documents must be attached and sent with the application.
Supply
> Not specified.
Ship To
> Medication will be shipped to the patient's home unless otherwise specified.
Note
>
 
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.
 
Increlex injection
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
Download printable Form
Download printable Form
Download printable Form
Download printable Form
Download printable Form
(Requires Acrobat Reader