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Patient Assistance Information

 
 
 
Venofer Patient Assistance Program (for Free Standing Dialysis Clinics only)

1901 Eastpoint Parkway
Louisville, KY 40223
Phone : (877)694-7661
Fax: (866)496-8638
Eligibility
> This program is intended for Patients with no prescription coverage. Medicare partD not eligible. Income requirements not disclosed. Must be a US resident or legal entrant.
Who Can Apply
> Clinic must call for application to be faxed or download. Return application via fax or mail. Clinic will be notified in writing within 24-48hrs of decision.
Required
> Diagnosis/medical criteria required: End Stage Renal Disease (585.6) and be on dialysis. Doctor must complete and sign application. Patient must complete application sign and attach proof of income.
Supply
> Amount/supply varies. Refill process not applicable. Refill limit not specified. New application must be completed every 12 months.
Ship To
> Ships to clinic in 1-3 business days.
Note
> After PAP application approval the provider must return the Venofer product order form for replacement product. Contact program for Spanish application.
 
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.
 
Venofer injection