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Korlym Patient Assistance Program
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149 Commonwealth Drive
Menlo Park, CA 94025
Phone
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(855)456-7596
Fax:
(877)858-7746
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Eligibility
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This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Household income must be at or less than $150,000 or Individual at or less than $75,000 & patient must reside in the US. |
| Who Can Apply
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Call for or download application which will be sent to the patient. Application must be returned by mail. |
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Required
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Patient must complete section, sign, & attach copy of proof of income. Patient will be notified of decision. |
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Supply
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Up to 30 day supply. Refill process & limit not specified. Re-application process not specified. |
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Ship To
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Medication will be sent to patient's home. |
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Note
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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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| Korlym tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form Korlym Patient Assistance Program |
(Requires Acrobat Reader) 
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