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Patient Assistance Information

 
2 Programs for Harvoni tablet
 
 
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.
 
Harvoni tablet
 
 
 
Support Path Patient Assistance Program


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Phone : (855)769-7284
Fax: (855)298-8700
Eligibility
> Must be uninsured and be ineligible for federal or state programs; or have a plan design limitation. Medicare Part D patients are not eligible for this program. Income must be a or below 500% of FPL* (see below). Must reside permanently in the US or US territories.
Who Can Apply
> Call to have application faxed, mailed or download from website. Return application via fax or mail. A decision will be received by phone or mail in 2 business days, once application process is complete.
Required
> Diagnosis/Medical Criteria *See Additional Information section below. Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information.
Supply
> Up to a 28 day supply. Company contacts patient to arrange refills. 2 enrollments per lifetime. Re-application process determined case by case.
Ship To
> Ship to Doctor's office or patient's home within 2-3 business days.
Note
> *500% FPL or less than $100k for the household This program also provides copay assistance. Patient must be diagnosed with Chronic Hepatitis C.
 
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.
 
Harvoni tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Support Path Patient Assistance Program
(Requires Acrobat Reader