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Connections for Growth Patient Assistance Program
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PO Box 29023
Phoenix, AZ 85038
Phone
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800-582-7989
Fax:
877-408-4288
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Eligibility
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This program is for Patient's with no prescription coverage for needed medication. Medicare Part D patients are not eligible for this program. Income requirements for this program have not been disclosed. The patient must be a US citizen or legal resident and a child. |
| 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. Patient and Doctor will be notified of acceptance within 5-7 business days. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information. |
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Supply
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Up to 3 month supply. New Prescription required with each refill. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Medication is sent to Patient's home within 2 weeks. |
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Note
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Doctor first needs to send statement of medical necessity form, and patient must first go through to the insurance verification program. Then an application will be sent out. The patient must also have been Stim tested in order to be eligible for this program. |
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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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| Saizen injection |
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Saizen Easy Savings Program
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,
Phone
:
(800)582-7989
Fax:
(877)408-4288
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Eligibility
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This program is intended for patients who may have insurance, but NOT have Medicaid. Medicare Part D patients are not eligible for this program. No income limits. MA residents are not eligible for this program. |
| Who Can Apply
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The Doctor should call for an application or download it from the website. Application must be faxed back to company from Doctor's office. Patient and Doctor are notified of decision. |
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Required
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Must have FDA approved diagnosis. Doctor must complete and fax Statement of Medical Necessity and signed Patient Authorization forms which are on the website. Patients just informs Doctor that he/she is in need. |
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Supply
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Amount/supply varies. Refill process not applicable. Refill limit maximum of 12 times in one year. Re-application process not applicable. |
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Ship To
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Shipping location not applicable. |
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Note
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Patients must not have filled a Saizen prescription in the past 6 months.
After program activation, patients can save up to $200 per month on monthly copay or coinsurance costs for 12 months.
This program runs and renews on an annual basis. |
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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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| Saizen injection |
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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 Saizen Easy Savings Program |
(Requires Acrobat Reader) 
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