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Diplomat's Co-Pay Assistance Navigator Program
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Attention FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507
Phone
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(877)977-9118
Ext 89864
Fax:
(810)282-0176
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Eligibility
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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
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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. |
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Required
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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. |
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Supply
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Amount requested is sent. Company contacts patient to arrange refills, refill limit varies. Re-applications are determined case by case. |
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Ship To
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Once approved medication is shipped to Patient's home within 2 business days. |
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Note
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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 |
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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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| Firazyr injection |
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OnePath Co-Pay Assistance Program
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Phone
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866-888-0660
Fax:
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Eligibility
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Patient may not have public insurance but may have private insurance. There are no income limits for this program. Patients must have a medically appropriate diagnosis/condition and must reside in the US. |
| Who Can Apply
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Patients must call for a prescreening. |
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Required
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Not applicable |
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Supply
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Not applicable |
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Ship To
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Not applicable |
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Note
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Program requires a confirmed diagnosis of type 1 Gaucher disease, Hunter syndrome or HAE. Copay Assistance only for Shire HGT medications only. |
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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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| Firazyr injection |
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OnePath Patient Assistance Program
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Phone
:
866-888-0660
Fax:
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Eligibility
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Patients must be uninsured or underinsured with no prescription coverage for the needed medication. Patients with Medicare Part D are not eligible. Income requirements for this program have not been disclosed. Patients must have a medically appropriate diagnosis/condition and must reside in the US. |
| Who Can Apply
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Patients must call for a prescreening and an application will be faxed or mailed. |
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Required
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Patients and doctors must each complete a section of the application and sign. It can then be returned by mail. |
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Supply
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1 dose |
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Ship To
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Doctor's office or infusion site |
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Note
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Program requires a confirmed diagnosis of type 1 Gaucher disease, Hunter syndrome or HAE. Program only covers Shire HGT medications.
Sharps Recovery System: Contact program for more detail. |
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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.
|
| Firazyr injection |
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