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Patient Assistance Information

 
4 Programs for Pomalyst capsule
 
 
Celgene Co-Pay Assistance Program

Celgene Corporation
86 Morris Avenue
Summit, NJ 07901
Phone : 800-931-8691
Fax: (800) 822-2496
Eligibility
> This program is intended for patients that have private insurance with a gross annual household income at or below $100,000 and are a US resident. Medicare Part D patients are not eligible for this program.
Who Can Apply
> Applicant must call for prescreening. Patient is then contacted if eligible after phone screening & will be contacted for any additional information. Patient and Doctor are notified within 24-48hrs of decision.
Required
>
Supply
> Supply and Refill process not applicable at this time. Re-application process not specified.
Ship To
> Not specified.
Note
> Please visit www.celgenepatientsupport.com for more information. No online application available.
 
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.
 
Pomalyst capsule
 
 
 
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.
 
Pomalyst capsule
 
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.
 
Pomalyst capsule
 
 
 
Patient Access Network Foundation (PAN)

PO Box 221858
Charlotte, NC 28222
Phone : (866)316-7263
Fax: (866)316-7263
Eligibility
> This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US.
Who Can Apply
> Patients or healthcare providers can complete the application online or by phone.
Required
> Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received.
Supply
> Not applicable
Ship To
> Patient sent card to be used at pharmacy
Note
> *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. 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. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
 
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.
 
Pomalyst capsule
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader