Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
 
 
RemiStart Patient Rebate Program and Extended Access Program

14001 Weston Parkway, Suite 103
Cary, NC 27513
Phone : 888-222-3771
Fax: 877-234-3048
Eligibility
> The RemiStart Patient Rebate Program and Extended Access Program is intended for patients that are commercially insured. Income requirements for this program have not been disclosed. Patients must be a resident of the US or Puerto Rico. This medication must be prescribed for an on-label diagnosis.
Who Can Apply
> Patients can obtain an application by calling, printing from the link below or by asking their doctor for one.
Required
> Application must be completed and signed by the doctor and the patient. Patient and/or doctor will be notified of a decision.
Supply
> Not specified.
Ship To
>
Note
> This program also provides copay assistance.
 
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.
 
Remicade (infliximab)
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader