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Patient Assistance Information

 
 
 
MS Lifelines


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Phone : (877)447-3243
Fax:
Eligibility
> Insurance requirements determined case by case. Medicare part D eligibility varies. Income requirements for this program have not been disclosed. Must be a US resident.
Who Can Apply
> Applicant must call for prescreening and application will be sent to the Patient via mail. Patient will be notified of decision within 7-10 business days.
Required
> Must have MS. Doctor must fax in prescription. Patient must complete application, sign, attach proof of income and other requested documentation.
Supply
> Amount/supply varies. Company contacts Patient to arrange refills. Refill limit not specified. New application and documentation required yearly.
Ship To
> Medication will be shipped to Patient's home once approved. Shipped same day.
Note
> Program does not use financial guidelines or an application for the first year of enrollment. They encourage patients to call the toll free number for assistance. 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.
 
Rebif syringe; subcutaneous