| |
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.
|
| Orkambi tablet |
| |
| |
|
|
| |
Vertex GPS (for Healthcare Professionals)
|
Vertex GPS KALYDECO Assistance Program
50 Northern Ave.
Boston, MA 02210
Phone
:
(877)752-5933
Fax:
(888)952-5933
|
|
Eligibility
|
| > |
Patients must meet income and diagnostic criteria that have not been disclosed and be a US resident. |
| Who Can Apply
|
| > |
Healthcare providers can call to have an application faxed, mailed or download one from the website. |
|
Required
|
| > |
Doctors and patients must each complete a section of the application and sign. The application must then be faxed or mailed from the doctor's office. |
|
Supply
|
| > |
Not applicable |
|
Ship To
|
| > |
Not applicable |
|
Note
|
| > |
Resources for HEALTHCARE PROFESSIONAL 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.
|
| Orkambi tablet |
| |
| |
|
|