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Patient Assistance Information

 
2 Programs for Adcirca tablet
 
 
ASSIST Program


,
Phone : (877)864-8437
Fax:
Eligibility
> Insurance status will be considered on a case by case status. Patients must meet income requirements that have not been disclosed and must reside and receive treatment in the US.
Who Can Apply
> Patients must call for a prescreening.
Required
> Doctors must provide patients with a prescription and patients must call to enroll.
Supply
> Not specified
Ship To
> Not specified
Note
> For information on Patient Assistance Programs that may be available for United Therapeutics Corporation products (Orenitram®, Remodulin®, Tyvaso®) or Lung Biotechnology's product (Adcirca®), please contact ASSIST at 877 864-8437
 
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.
 
Adcirca 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.
 
Adcirca tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Good Days Program
(Requires Acrobat Reader