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Patient Assistance Information

 
2 Programs for Bethkis solution; inhalation
 
 
Chiesi CAREDIRECT (Bethkis, Pertzye)

Chiesi CareDirect Patient Assistance Program
PO Box 30317
Bethesda, MD 20824
Phone : 888-865-1222
Fax: 866-410-6241
Eligibility
> This program is intended for patients that are uninsured or are underinsured with no prescription coverage and are a US citizen or legal entrant. Medicare Part D patients are not eligible for this program. Must provide diagnosis code. Income must be at or below 400% of FPL.
Who Can Apply
> Doctors and Patients can call to request an application via fax, email or download one from the website. The application may be returned via fax or mail.
Required
> Doctors and patients must complete and sign the application. Patient must attach proof of income and other requested documentation. Patient and Doctor are notified within 1-2 business days.
Supply
> Amount supplied as prescribed by Doctor
Ship To
> Medication is shipped to Patient's home. Refills are automatically sent out and the Patient must submit a new application every 12 months.
Note
> This program was formerly known as Cornerstone CAREDIRECT. The program also includes copay assistance and a nutritional rebate program. The nutritional rebate program is for Pertzye patients only.
 
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.
 
Bethkis solution; inhalation
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Chiesi CareDirect PAP
(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.
 
Bethkis solution; inhalation