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R-Pharm US Access and Support Program
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c/o Sonexus Health
2730 S. Edmonds Lane Suite 300
Lewisville, TX 75067
Phone
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855-991-7277
Fax:
877-541-7813
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Eligibility
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Patients must be uninsured, at or below 300% of the Federal Poverty Level, have an FDA-approved diagnosis and be a US citizen. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed. |
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Required
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Doctor and patient must each complete a section and sign. The application can be returned by fax. |
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Supply
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Not specified |
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Ship To
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Not specified |
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Note
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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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| Ixempra |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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