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Diplomat's Co-Pay Assistance Navigator Program
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Attention FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507
Phone
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(877)977-9118
Ext 89864
Fax:
(810)282-0176
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Eligibility
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Insurance determined case by case. Medicare Part D patients are eligible for this program. Income requirements determined case by case. Must be a US resident. Must have medically appropriate condition/diagnosis. |
| Who Can Apply
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Patient or Doctor may call to receive application via fax or mail. May also complete application online. Application is to be mailed or faxed back to company. |
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Required
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Doctor's action will be discussed with patient and Doctor after request is received. Patient must complete application, sign and provide annual income information. Proof of income may be requested by program at any time. Patient and/or Doctor are notified of decision within 1-2 business days. |
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Supply
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Amount requested is sent. Company contacts patient to arrange refills, refill limit varies. Re-applications are determined case by case. |
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Ship To
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Once approved medication is shipped to Patient's home within 2 business days. |
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Note
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Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie |
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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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| Actemra injection |
| Afinitor tablet |
| Alimta injection |
| Alkeran tablet |
| Ampyra tablet; extended release |
| Aranesp vial |
| Arimidex tablet |
| Aubagio tablet |
| Avonex Injection |
| Betaseron vial |
| Bethkis solution; inhalation |
| Boniva injectable; iv |
| Boniva tablet |
| Bosulif tablet |
| Cabometyx |
| Caphosol Oral Solution |
| Casodex tablet |
| Cimzia injection |
| Cometriq capsule |
| Copaxone syringe; prefilled |
| Cotellic |
| Cuvposa oral solution |
| Dacogen injection |
| Daklinza |
| Eligard injection |
| Emend capsule |
| Entyvio |
| Epogen injection |
| Erbitux |
| Erivedge capsule |
| Esbriet capsule |
| Exjade tablet |
| Farydak capsule |
| Faslodex Injection |
| Femara tablet |
| Firazyr injection |
| Forteo injectable; subcutaneous |
| Fuzeon injectable; subcutaneous |
| Gazyva injection |
| Genotropin injection |
| Genotropin MiniQuick syringe; prefilled |
| Gilenya |
| Gleevec tablet |
| Harvoni tablet |
| Herceptin vial; iv |
| Hetlioz |
| Humatrope injection |
| Humira Injection |
| Hycamtin capsule |
| Ibrance capsule |
| Iclusig tablet |
| Imbruvica capsule |
| Infergen vial |
| Inlyta tablet |
| Intron A vial |
| Iressa |
| Jadenu |
| Jakafi tablet |
| Kadcyla vial; single-use |
| Kalydeco tablet |
| Keveyis tablet |
| Kitabis Pak inhalation solution |
| Lonsurf |
| Lupron Depot injection |
| Mekinist tablet |
| Neupogen syringe |
| Neupogen vial |
| Nexavar tablet |
| Nilandron |
| Ninlaro |
| Nplate injectable; subcutaneous |
| Nucala |
| Nutropin cartridge |
| Olysio capsule |
| Orencia injectable; iv (infusion) |
| Orkambi tablet |
| Otezla tablet |
| Pegasys syringe |
| PegIntron vial |
| Pomalyst capsule |
| Praluent |
| Prialt injectable; intrathecal |
| Procrit vial |
| Prolia injectable; subcutaneous |
| Promacta |
| Rebif syringe; subcutaneous |
| Remicade |
| Revlimid capsule |
| Ribasphere capsule |
| Ribasphere RibaPak capsule |
| Sancuso transdermal patch |
| Serostim injection |
| Simponi |
| Simponi Aria |
| Soltamox solution |
| Somatuline Depot injection |
| Sovaldi tablet |
| Sprycel tablet |
| Stelara injection |
| Stivarga tablet |
| Sutent Capsule |
| Sylatron vial |
| Synagis injection |
| Synribo powder; subcutaneous |
| Tafinlar capsule |
| Tagrisso tablet |
| Tarceva tablet |
| Targretin capsule |
| TARGRETIN® (bexarotene) Gel |
| Tasigna capsule |
| Tecfidera capsule; delayed release |
| Temodar capsule |
| Thalomid capsule |
| Thyrogen injection |
| Tobi Podhaler powder; inhalation |
| Tobi solution; inhalation |
| Trelstar injectable; intramuscular |
| Tykerb tablet |
| Tyzeka tablet |
| Velcade injectable; subcutaneous |
| Venofer injection |
| Victrelis capsule |
| Vidaza injectable; subcutaneous |
| Votrient tablet |
| Xalkori capsule |
| Xeljanz tablet |
| Xeloda tablet |
| Xtandi capsule |
| Zelboraf |
| Zelboraf tablet |
| Zepatier |
| Zofran tablet |
| Zoladex Implant |
| Zolinza capsule |
| Zometa injection |
| Zorbtive injection |
| Zydelig tablet |
| Zykadia capsule |
| Zytiga tablet |
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