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Connections for Growth Patient Assistance Program
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PO Box 29023
Phoenix, AZ 85038
Phone
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800-582-7989
Fax:
877-408-4288
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Eligibility
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This program is for Patient's with no prescription coverage for needed medication. Medicare Part D patients are not eligible for this program. Income requirements for this program have not been disclosed. The patient must be a US citizen or legal resident and a child. |
| Who Can Apply
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Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form. Application is sent to Patient. Patient and Doctor will be notified of acceptance within 5-7 business days. |
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Required
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The doctor must fill out a section and sign the application.The patient must fill out a section, sign the application and attach proof of income and any insurance information. |
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Supply
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Up to 3 month supply. New Prescription required with each refill. Refill limit not specified. New application must be completed yearly. |
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Ship To
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Medication is sent to Patient's home within 2 weeks. |
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Note
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Doctor first needs to send statement of medical necessity form, and patient must first go through to the insurance verification program. Then an application will be sent out. The patient must also have been Stim tested in order to be eligible for this program. |
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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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| Saizen injection |
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