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Patient Assistance Information

Core Connections Program

4500 Progress Blvd.
Louisville, KY 40218
Phone : 855-336-3322
Fax: 800-481-3325
> The Core Connections Program provides brand name medications at no or low cost. Patient that have insurance are eligible. Patients must be at or below 250% of the federal poverty level. They must also have an FDA-approved diagnosis and be a US citizen or legal resident.
Who Can Apply
> Patients and doctors can call or download the application from the link below.
> The application must be completed and signed by the doctor and the patient. It must be faxed from the doctor's office along with required documentation. A new application is needed yearly.
> Up to 1 month supply
Ship To
> Patient's home, unless otherwise noted.
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.
Rasuvo injection
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
(Requires Acrobat Reader