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Sigma-Tau Patient Assistance Program and Reimbursement Services
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200 Pinecrest
Morgantown, WV 26050
Phone
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800-490-3262
Fax:
866-694-2544
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Eligibility
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Patients must have no coverage for the requested medication and be ineligible for federal or state programs. Patients must be at or below 300% of the Federal Poverty Level. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed, mailed or emailed. |
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Required
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Doctors must complete a section, sign, attach prescription and include their DEA and state license number. Patients must complete a section, sign, and attach a copy of proof of income. |
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Supply
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Up to 3 months supply |
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Ship To
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Doctor's office or infusion site |
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Note
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Insurance benefits, claims assistance and/or other reimbursement help is offered.
Contact program for Spanish application. |
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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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| Abelcet (amphotericin B lipid complex injection) |
| Depocyt (cytarabine liposome) |
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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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