Registered Users Log-in:

E-mail Address:
 

Password:
 

  
Forgot Password?
Registration
 
Patient Assistance Information

 
 
 
Extavia Go Program

Customer Interaction CenterNovartis
Pharmaceuticals Corporation
East Hanover, NJ 07936
Phone : (866)925-2333
Fax:
Eligibility
> This program provides brand name medications at no or low cost. Patient insurance status will be considered on a case by case basis. Patients with Medicare Part D will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must have an FDA-approved diagnosis and be a US resident.
Who Can Apply
> Patients or doctors can call to have an application faxed or mailed.
Required
> Doctors must complete and sign a section of the application. Patients also complete a section of the application, sign, attach proof of income and attach any insurance information. The application can then be faxed or mailed.
Supply
> Varies
Ship To
> Card obtained from doctor's office
Note
> Eligibility determined on a case-by-case basis.
 
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.
 
Extavia injection