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Patient Assistance Information

 
2 Programs for Nascobal spray; nasal
 
 
Good Days Program

6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone : (877)968-7233
Fax: (214)570-3621
Eligibility
> 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
> 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.
Required
> Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents.
Supply
> Refill process and limit not specified. Must re-enroll at the end of every calendar year.
Ship To
> Shipping location not specified.
Note
> 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.
 
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.
 
Nascobal spray; nasal
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader
 
 
Nascobal Patient Assistance Program

1267 Professional Parkway
Gainsville, GA 30507
Phone : (800)589-0841
Fax: (855)828-1491
Eligibility
> This program is intended for Patients with no prescription insurance coverage, this includes Medicare partD patients. Income must be at or below 200% of FPL and a US resident. Diagnosis/medical criteria not specified.
Who Can Apply
> Call for fax or mailed application or download from website. Application must be returned from the prescriber's office via fax or mail. Decision will be communicated within 2-3 days.
Required
> Doctor must complete and sign application. Patient must complete application, sign and attach required documents.
Supply
> Amount/supply varies. Copy of application with new signatures and new prescription required for refills. Refill limit not specified. Company contacts patient about reapplying after 6 months.
Ship To
> Medication ships to Doctor's office within 2 days.
Note
>
 
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.
 
Nascobal spray; nasal
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Nascobal Patient Assistance Program
(Requires Acrobat Reader