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Patient Assistance Information

 
1 Program for Azor tablet
 
 
Daiichi Sankyo Open Care Program

PO Box 8409
Somerville, NJ 08876
Phone : 866-268-7327 Ext 1
Fax: Not Applicable
Eligibility
> This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Patient's income must be at or below 200% FPL. Must be citizen or legal resident.
Who Can Apply
> The physician's office must call for application, which will be faxed. Application can be returned via fax or mail. Patient will be notified of denial in writing.
Required
> Doctor must complete section, sign, attach required documents. Patient must complete section, sign, attach a copy of proof of income.
Supply
> Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application and documentation is required yearly.
Ship To
> Medication is sent to Doctor's office within 2 weeks.
Note
> 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.
 
Azor tablet