Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
 
 
REACH (Resources for Expert Assistance and Care Helpline)

PO Box 221289
Charlotte, NC 28222-1289
Phone : 877-322-4448
Fax: 866-639-5181
Eligibility
> The patient may be uninsured or be insured but experiencing difficulty accessing the medications. the patient must also also have limited financial resources.
Who Can Apply
> With the patient's permission, anyone concerned can call for an application.
Required
> The doctor must complete the appropriate section and sign the application.The patient must also complete, sign the application and attach proof of income.
Supply
>
Ship To
> Doctor's office
Note
> With the patient's permission, anyone concerned can call for an application.
 
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.
 
Campath
Fludara (fludarabine phosphate)
Leukine (sargramostim)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Application Form
(Requires Acrobat Reader