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Good Days Program
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6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone
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(877)968-7233
Fax:
(214)570-3621
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Eligibility
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Insurance requirements not specified, this includes Medicare PartD. Income requirements for this program have not been disclosed. US residency requirements not specified. |
| Who Can Apply
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Call to have application faxed, mailed, download from website or apply online. Return application via fax, mail or submit online. Patient and/or Doctor are notified of decision. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents. |
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Supply
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Refill process and limit not specified. Must re-enroll at the end of every calendar year. |
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Ship To
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Shipping location not specified. |
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Note
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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. |
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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.
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| Glatopa injection |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Good Days Program |
(Requires Acrobat Reader) 
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Novartis Patient Assistance Foundation, Inc.
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PO Box 52029
Phoenix, AZ 85072
Phone
:
800-277-2254
Fax:
855-817-2711
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Eligibility
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This program provides brand name medications at no or low cost to patients that have no prescription coverage. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must be a US resident. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
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Required
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Doctors must complete a portion of the application, sign and attach a prescription for 90 days. Patients must complete a portion of the application, sign and attach a copy of proof of income. |
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Supply
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Varies |
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Ship To
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Doctor's office or patient is sent card to be used at pharmacy. |
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Note
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For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician. |
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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.
|
| Glatopa injection |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| Download printable Form |
| (Requires Acrobat Reader)
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