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Patient Assistance Information

 
 
 
Lemtrada REMS Program


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Phone : (855)676-6326
Fax: (855)557-2478
Eligibility
> Insurance requirements for this program are not specified. Medicare PartD eligibility not specified. Income requirements not disclosed. Must be US resident.
Who Can Apply
> Call to have application faxed or download from website. Application must be faxed back to company from Doctor's office. Patient and Doctor are notified of decision. Decision timeframe varies.
Required
> Must have MS. Doctor must enroll in the program. Patient must inform Doctor that he/she is in need.
Supply
> Amount/supply not specified. Refill process and limit not specified. Re-application process not specified.
Ship To
> Not specified.
Note
> Prescribing Physician, Healthcare Facilities, Pharmacies and Patients must enroll into the Risk Evaluation and Mitigation Strategy (REMS) Program prior to initiating the patient on treatment with LEMTRADA. Contact program for more detail.
 
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.
 
Lemtrada
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form Lemtrada REMS Program
(Requires Acrobat Reader