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Patient Assistance Information

 
1 Program for imatinib tablet
 
 
Sun Pharmaceutical Imatinib Patient Assistance Program


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Phone : 844-502-5950
Fax: 866-810-3258
Eligibility
> Patients must have no prescription coverage for the needed medication. Medicare Part D recipients are not eligible. Patients must be at or below 500% of the Federal Poverty Level or have experienced a recent financial challenge (supporting documentation required). They must also have an FDA-approved diagnosis and be a US resident, have a green card or work visa.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors and patients must each complete a section, sign the application and attach required documents.
Supply
> 30 day supply
Ship To
> Patient's home, unless otherwise noted
Note
> *If a patient qualifies, they may receive free medication monthly through July 2016 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.
 
imatinib tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader