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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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| Venofer injection |
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Venofer Patient Assistance Program (for Free Standing Dialysis Clinics only)
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1901 Eastpoint Parkway
Louisville, KY 40223
Phone
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(877)694-7661
Fax:
(866)496-8638
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Eligibility
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This program is intended for Patients with no prescription coverage. Medicare partD not eligible. Income requirements not disclosed. Must be a US resident or legal entrant. |
| Who Can Apply
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Clinic must call for application to be faxed or download. Return application via fax or mail. Clinic will be notified in writing within 24-48hrs of decision. |
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Required
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Diagnosis/medical criteria required: End Stage Renal Disease (585.6) and be on dialysis. Doctor must complete and sign application. Patient must complete application sign and attach proof of income. |
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Supply
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Amount/supply varies. Refill process not applicable. Refill limit not specified. New application must be completed every 12 months. |
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Ship To
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Ships to clinic in 1-3 business days. |
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Note
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After PAP application approval the provider must return the Venofer product order form for replacement product.
Contact program for Spanish application. |
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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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| Venofer injection |
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