Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
2 Programs for Letairis tablet
 
 
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.
 
Letairis tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader
 
 
Patient Assistance Solutions Program for Letairis

po bOX 13185
La Jolla, CA 92039
Phone : (866)664-5327
Fax: (888)856-7991
Eligibility
> This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Income based on FPL. Must be a US resident.
Who Can Apply
> Call to have application faxed, mailed or download from website. Application must be returned from Doctor's office via fax or mail. Patient and Doctor notified in writing in 3-5 business days.
Required
> Medically appropriate condition/diagnosis required. Doctor and patient must complete and sign application.
Supply
> Up to 30 day supply. Patient contacts pharmacy for refills. No refill limit. Re-application process determined case by case.
Ship To
> Ship to Patient's home, unless otherwise noted with 2 business days.
Note
> The prescriber must also be enrolled in the program using Letaris Physician Form. Female patients must first be enrolled in LEAP (Letairis Education and Access Program) in order to access this program. This program also provides copay assistance.
 
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.
 
Letairis tablet