| |
ONFI Patient Assistance Program
|
,
Phone
:
855-345-6634
Fax:
855-547-8278
|
|
Eligibility
|
| > |
ONFI Patient Assistance Program eligibility is determined on a case by case basis. Income requirements have not been disclosed for this program. Medication must be medically necessary as determined by a doctor. US residency requirements have not been specified. |
| Who Can Apply
|
| > |
Doctors |
|
Required
|
| > |
Doctors must send a referral form to the program to begin the application process. The form can be faxed, mailed or downloaded. Doctors must complete and sign and fax or mail from their office. |
|
Supply
|
| > |
Not specified |
|
Ship To
|
| > |
Not specified |
|
Note
|
| > |
Resources for HEALTHCARE PROFESSIONAL ONLY.
This program also provides copay assistance. |
| |
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.
|
| Onfi tablet |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
(Requires Acrobat Reader) 
|
| |
|
|