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Patient Assistance Information

 
2 Programs for Pertzye capsule; delayed release
 
 
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.
 
Pertzye capsule; delayed release
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Chiesi CareDirect PAP
(Requires Acrobat Reader
 
 
Pertzye Assistance Program


1120 Win Drive
Bethlehem, PA 18017
Phone : 610-882-5950
Fax: 610-882-0349
Eligibility
> Insurance is determined case by case. Medicare Part D patients are not eligible for this program. Income requirements are determined case by case. US residency not specified.
Who Can Apply
> Doctor/Doctor's office must call and have application faxed to the office. Application is returned via fax. Doctor will be notified of decision.
Required
> Doctors and patients must complete and sign the application.
Supply
> Up to 3 month supply. New application process required for refills. Refill limit not specified.
Ship To
> Medication shipped to Doctor's office within 5-7 business days.
Note
> **Physicians apply for this program on behalf of their patients. Each applicant is looked at on a case by case basis. If another supply is needed, the physician is to submit another enrollment form. This program also provides copay assistance and has a Nutritional Rebate Program.
 
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.
 
Pertzye capsule; delayed release