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Good Days Program
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6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone
:
(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.
|
| Ixempra |
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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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R-Pharm US Access and Support Program
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c/o Sonexus Health
2730 S. Edmonds Lane Suite 300
Lewisville, TX 75067
Phone
:
855-991-7277
Fax:
877-541-7813
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Eligibility
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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
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Patients or healthcare providers can call to have an application faxed. |
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Required
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Doctor and patient must each complete a section and sign. The application can be returned by fax. |
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Supply
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Not specified |
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Ship To
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Not specified |
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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)
|
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