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Sunovion Support Prescription Assistance Program
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PO Box 220285
Charlotte, NC 28222
Phone
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(877)850-0819
Fax:
(877)850-0821
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Eligibility
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The patient must be a resident of the United States, Puerto Rico, or the US Virgin Islands, and be 18 years of age or older. They must not have prescription coverage (this includes Medicare and Medicaid). The patient must have a household annual income at or below 300% of the Federal Poverty Level. |
| Who Can Apply
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The patient can obtain an application by mail or by download. It must be returned via mail or faxed. |
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Required
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The patient must complete and sign a portion of the application and attach proof of income. The physician must also complete and sign a portion of the application. A decision will be made within 48 hours and the patient will receive notification in writing. |
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Supply
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Up to 90 day supply |
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Ship To
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The medication will be sent to the physician's office or a card is sent to the patient's address to be used at the pharmacy. |
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Note
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The patient must complete a new application yearly. |
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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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| Latuda Tablet |
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