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Patient Assistance Information

Novartis Oncology Patient Assistance Program

PO Box 52029
Phoenix, AZ 85072
Phone : 866-884-5906
Fax: 888-891-4924
> This program provides brand name medications at no or low cost to patients that have no prescription coverage. Medicare Part D recipients will be considered on an exception basis. Income requirements for this program have not been disclosed. Patients must be a US resident.
Who Can Apply
> Doctors must ask for service request and have the application faxed or mailed to them.
> Doctors must complete a portion of the application, sign and attach a prescription. Patients must complete a portion of the application, sign and attach proof of income and any insurance information.
> Not specified
Ship To
> Doctor's office or patient's home
> Eligibility determined on a case-by-case basis. Uninsured patients, call 1-866-884-5906 Patients with insurance, call 1-800-282-7630 This program also provides copay assistance up to $36,000 per year for Signifor and $9,600 per year for Sandostatin. Carcinoid tumor patients are now eligible.
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.
Afinitor Disperz tablet
Afinitor tablet
Arranon Injection
Arzerra injection
Farydak capsule
Gleevec tablet
Hycamtin capsule
Hycamtin Injection
Mekinist tablet
Odomzo capsule
Sandostatin LAR injection
Signifor LAR
Tafinlar capsule
Tasigna capsule
Votrient tablet
Zykadia capsule
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
(Requires Acrobat Reader