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CORE Patient Assistance Program
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PO Box 7588
Overland Park, KS 66207
Phone
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888-587-3263
Fax:
866-676-4073
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Eligibility
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Patients must have no prescription coverage for the needed medication, be at or below 500% of the Federal Poverty Level, have a medically appropriate diagnosis/condition and be a citizen or legal resident. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or mailed. It can also be downloaded. |
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Required
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Doctors must complete a section and sign. Patients must complete a section, sign, attach a copy of proof of income, and attach front and back copy of insurance card. |
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Supply
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Not specified |
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Ship To
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Doctor's office |
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Note
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Contact program for Spanish application. |
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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.
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| Treanda injection |
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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 |
(Requires Acrobat Reader) 
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