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Patient Assistance Information

Kineret OnTrack Support Program

Phone : 866-547-0644
Fax: 866-549-7219
> 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
> Patients or healthcare providers can call to have an application faxed or download one.
> 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.
> Up to 30 day supply
Ship To
> Varies
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.
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
Download printable Form
Download printable Form
(Requires Acrobat Reader