| |
Spectrum Therapy Access Resources (STAR) Program
|
PO Box 220551
PO Box 220684
Charlotte, NC 28222
Phone
:
(888)537-8277
Fax:
|
|
Eligibility
|
| > |
Patients must be uninsured or underinsured, meet income requirements that have not been disclosed and be a US citizen or permanent resident. The medication must be used for outpatient use only. |
| Who Can Apply
|
| > |
Patients or healthcare providers can call to have an application faxed or mailed. It can also be downloaded. |
|
Required
|
| > |
Doctors must complete a section and sign. Patients must complete a section, sign and attach insurance information. |
|
Supply
|
| > |
Varies |
|
Ship To
|
| > |
Doctor's office |
|
Note
|
| > |
Insurance benefits, claims assistance,/or other reimbursement help is offered. |
| |
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.
|
| Beleodaq |
| Folotyn |
| Fusilev |
| Marqibo injectable; iv |
| Zevalin injectable; iv (yttrium-90 ) |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form |
| Download printable Form |
| Download printable Form |
| Download printable Form |
| Download printable Form |
(Requires Acrobat Reader) 
|
| |
|
|