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Patient Assistance Information

 
 
 
Serostim Patient Assistance Program

PO Box 9535
Louisville, KY
Phone : (877)714-2947 Ext opt.2
Fax: (800)214-8698
Eligibility
> This program is intended for patients that are uninsured for needed medication. Medicare Part D patients are not eligible for this program. Income requirements for this program have not been disclosed. Must be US resident or legal alien.
Who Can Apply
> Doctor/Doctor's office starts process by filling out Statement of Medical Necessity Form. Application is sent to Patient's home. Patient and Doctor will be notified in writing within 5-7 business days.
Required
> Doctor must complete and fax Statement of Medical Necessity and signed Patient Authorization forms which are on the website. Patient must complete application, sign and attach a copy of proof of income.
Supply
> Up to a 3 month supply. New prescription required for every refill. Refill limit not specified. New application must be completed every 6 months.
Ship To
> Medication will be sent to Patient's home or Doctor's office within 2 weeks.
Note
> Patients must first go through their insurance investigation process and must be referred by the AXIS Center case manager to the PAP. If they are referred to the PAP, they will receive an application to be completed. Serostim Copay Assistance Program: Good for up to 6 uses within a 12 month period: no more than once every 21 days. Company will cover up to $1,500 per month.
 
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.
 
Serostim injection