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Patient Assistance Information

 
2 Programs for Vidaza injectable; subcutaneous
 
 
Celgene Patient Support

Celgene Corporation
Summit, NJ 07901
Phone : 800-931-8691
Fax: 800-822-2496
Eligibility
> This program is intended for patients that may have insurance, this includes Medicare Part D patients. Income requirements for this program have not been disclosed. Patient must be a US resident with prescription from US doctor.
Who Can Apply
> Anyone requesting assistance can call to request an application to me mailed, faxed or download it from the website. Application needs to be returned via fax or mail.
Required
> The doctor must complete section and sign the application. The patient must complete section, sign, attach proof of income and any insurance information. Patient and Doctor will be notified of acceptance within 24-48 hours.
Supply
> Up to 1 month supply. Patient or Doctor must contact company for refills. Company will contact patient about reapplying.
Ship To
> Doctor's office or patient's home.
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.
 
Vidaza injectable; subcutaneous
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Celgene Patient Assistance Application
(Requires Acrobat Reader
 
 
Diplomat's Co-Pay Assistance Navigator Program

Attention FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507
Phone : (877)977-9118 Ext 89864
Fax: (810)282-0176
Eligibility
> Insurance determined case by case. Medicare Part D patients are eligible for this program. Income requirements determined case by case. Must be a US resident. Must have medically appropriate condition/diagnosis.
Who Can Apply
> Patient or Doctor may call to receive application via fax or mail. May also complete application online. Application is to be mailed or faxed back to company.
Required
> Doctor's action will be discussed with patient and Doctor after request is received. Patient must complete application, sign and provide annual income information. Proof of income may be requested by program at any time. Patient and/or Doctor are notified of decision within 1-2 business days.
Supply
> Amount requested is sent. Company contacts patient to arrange refills, refill limit varies. Re-applications are determined case by case.
Ship To
> Once approved medication is shipped to Patient's home within 2 business days.
Note
> Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie
 
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.
 
Vidaza injectable; subcutaneous