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Patient Assistance Information

 
 
 
Phoslyra Patient Assistance Program

1901 Eastpoint Parkway
Louisville, KY 40223
Phone : (877)774-6756
Fax: (866)496-8638
Eligibility
> This program is intended for patients without prescription coverage. Medicare partD patients are eligible, but contact program for details. Income requirements are not disclosed. Must be a US citizen or legal resident.
Who Can Apply
> Call for application to be faxed or mailed or download application. Fax application back to company. Patient and Doctor will be notified in writing within 24-48hrs.
Required
> Must be on dialysis. Must have diagnosis of End Stage Renal Disease (ESRD). Doctor must complete and sign application. Patient must complete application, sign, attach proof of income and any insurance information.
Supply
> Up to 60 day supply. Patient and Doctor must contact company for refills. Refill limit not specified. Every 6 months or 12/31 of each year, whichever comes first, new application must be completed.
Ship To
> Shipped to Patients house within 7-10 business days.
Note
> This program also provides copay assistance.
 
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.
 
Phoslyra oral solution
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Phoslyra Patient Assistance Program
(Requires Acrobat Reader