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Kineret OnTrack Support Program
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Phone
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866-547-0644
Fax:
866-549-7219
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Eligibility
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Patients must be uninsured, meet income requirements that have not been disclosed, have a medically necessary diagnosis that has been determined by a doctor and be a US citizen or legal resident. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
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Required
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Doctors must complete a section, sign, and attach a brand name prescription. Patients must complete a section, sign, attach proof of income and attach any insurance information. |
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Supply
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Up to 30 day supply |
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Ship To
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Varies |
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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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| Kineret |
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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 |
| Download printable Form |
(Requires Acrobat Reader) 
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