| |
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.
|
| Thyrogen injection |
| |
| |
|
|
| |
ThyrogenONE Reimbursement Support
|
Genzyme Corporation
500 Kendall St.
Cambridge, MA 02142
Phone
:
(888)497-6436
Fax:
(888)326-1002
|
|
Eligibility
|
| > |
Insurance requirements for this program are not specified, this includes Medicare PartD. Income requirements are not specified. US residency not required. |
| Who Can Apply
|
| > |
Call for application to be faxed or download from website. Return application via fax. Patient and Doctor or Specialty Pharmacy are notified. Decision timeframe varies. |
|
Required
|
| > |
Medically appropriate condition/diagnosis required. Doctor must complete section and sign. Patient must complete section, sign, attach insurance information. |
|
Supply
|
| > |
Amount/supply not specified. Refill process and limit not specified. Re-application process not specified. |
|
Ship To
|
| > |
Not specified. |
|
Note
|
| > |
Resources for HEALTHCARE PROFESSIONAL ONLY.
This program also provides copay assistance. |
| |
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.
|
| Thyrogen injection |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form ThyrogenONE Reimbursement Support |
(Requires Acrobat Reader) 
|
| |
|
|