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Patient Assistance Information

 
2 Programs for Ixempra
 
 
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.
 
Ixempra
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader
 
 
R-Pharm US Access and Support Program

c/o Sonexus Health
2730 S. Edmonds Lane Suite 300
Lewisville, TX 75067
Phone : 855-991-7277
Fax: 877-541-7813
Eligibility
> Patients must be uninsured, at or below 300% of the Federal Poverty Level, have an FDA-approved diagnosis and be a US citizen.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed.
Required
> Doctor and patient must each complete a section and sign. The application can be returned by fax.
Supply
> Not specified
Ship To
> Not specified
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.
 
Ixempra
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader