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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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| Serostim injection |
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Serostim Patient Assistance Program
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PO Box 9535
Louisville, KY
Phone
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(877)714-2947
Ext opt.2
Fax:
(800)214-8698
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Eligibility
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This program is intended for patients that are uninsured for needed medication. Medicare Part D patients are not eligible for this program. Income requirements for this program have not been disclosed. Must be US resident or legal alien. |
| Who Can Apply
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Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form. Application is sent to Patient's home. Patient and Doctor will be notified in writing within 5-7 business days. |
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Required
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Doctor must complete and fax Statement of Medical Necessity and signed Patient Authorization forms which are on the website. Patient must complete application, sign and attach a copy of proof of income. |
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Supply
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Up to a 3 month supply. New prescription required for every refill. Refill limit not specified. New application must be completed every 6 months. |
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Ship To
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Medication will be sent to Patient's home or Doctor's office within 2 weeks. |
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Note
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Patients must first go through their insurance investigation process and must be referred by the AXIS Center case manager to the PAP. If they are referred to the PAP, they will receive an application to be completed.
Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more than once every 21 days. Company will cover up to $1,500 per month. |
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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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| Serostim injection |
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