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Good Days Program
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6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone
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(877)968-7233
Fax:
(214)570-3621
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Eligibility
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Insurance requirements not specified, this includes Medicare PartD. Income requirements for this program have not been disclosed. US residency requirements not specified. |
| Who Can Apply
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Call to have application faxed, mailed, download from website or apply online. Return application via fax, mail or submit online. Patient and/or Doctor are notified of decision. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents. |
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Supply
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Refill process and limit not specified. Must re-enroll at the end of every calendar year. |
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Ship To
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Shipping location not specified. |
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Note
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Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. |
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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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| Genotropin |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Good Days Program |
(Requires Acrobat Reader) 
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Pfizer Bridge Program
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P.O. Box 220746
Charlotte, NC 28222
Phone
:
800-645-1280
Fax:
800-479-2562
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Eligibility
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The patient must be uninsured or underinsured and meet income guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis.The patient must also be a US resident. |
| Who Can Apply
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With the patient's permission, anyone concerned can call for an application. |
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Required
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The doctor must complete and sign the Statement of Medical Necessity Form. The patient must complete and sign the application and the Patient Authorization Form. |
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Supply
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Up to a 30-day supply |
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Ship To
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Patient's home |
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Note
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With the patient's permission, anyone concerned can call for an 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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| Genotropin |
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