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Good Days Program
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6900 dallas Parkway
Suite 200
Plano, TX 75024
Phone
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(877)968-7233
Fax:
(214)570-3621
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Eligibility
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Insurance requirements not specified, this includes Medicare PartD. Income requirements for this program have not been disclosed. US residency requirements not specified. |
| Who Can Apply
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Call to have application faxed, mailed, download from website or apply online. Return application via fax, mail or submit online. Patient and/or Doctor are notified of decision. |
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Required
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Diagnosis/Medical Criteria not specified. Doctor gives prescription to patient. Patient must complete application, sign and attach required documents. |
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Supply
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Refill process and limit not specified. Must re-enroll at the end of every calendar year. |
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Ship To
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Shipping location not specified. |
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Note
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Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. |
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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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| Abraxane injection |
| Actimmune |
| Adcetris |
| Adcirca tablet |
| Afinitor |
| Agrylin |
| Alimta |
| Arimidex |
| Aromasin |
| Aubagio |
| Avastin |
| Avonex |
| Bactrim |
| Baraclude |
| Betaseron |
| Buphenyl |
| Camptosar |
| Caprelsa |
| Cimzia |
| Clolar |
| Cometriq |
| Copaxone |
| Cotellic |
| Cystagon |
| Cystaran ophthalmic solution |
| Cytoxan |
| Dacogen |
| Daklinza |
| Darzalex |
| Desferal |
| Docefrez |
| Eloxatin |
| Entocort EC |
| Epivir |
| Erbitux |
| Exjade |
| Extavia |
| Eylea |
| Fareston |
| Faslodex |
| Ferriprox |
| Flolan injection |
| Gemzar |
| Genotropin |
| Gilenya |
| Gilotrif |
| Glatopa injection |
| Gleevec |
| Halaven |
| Harvoni |
| Hepsera |
| Herceptin |
| Humatrope |
| Humira |
| Ibrance |
| Iclusig |
| Iluvien implant |
| Incivek |
| Increlex injection |
| Infergen |
| Intron A |
| Isordil |
| Ixempra |
| Jadenu |
| Jakafi |
| Jetrea injection |
| Kadcyla |
| Keytruda |
| Lemtrada |
| Letairis tablet |
| Lonsurf |
| Lucentis |
| Macugen |
| Matulane |
| Mekinist |
| Moderiba tablet |
| Nascobal spray; nasal |
| Navelbine |
| Nexavar |
| Norditropin |
| Nutropin |
| Olysio |
| Omnitrope |
| Onmel |
| Opdivo |
| Opsumit tablet |
| Orenitram tablet; extended release |
| Pegasys |
| PegIntron |
| Perjeta |
| Pomalyst |
| Prednisolone oral solution |
| Procysbi capsule; delayed release |
| Proleukin |
| Provenge |
| Ravicti liquid |
| Rebetol |
| Rebif |
| Remicade |
| Remodulin injection |
| Revatio |
| Revlimid |
| Ribasphere |
| Roferon-A |
| Saizen |
| Serostim |
| Signifor |
| Soltamox |
| Sovaldi |
| Sporanox |
| Sprycel |
| Stivarga |
| Sutent |
| Synribo |
| Tafinlar |
| Tagrisso tablet |
| Tarceva |
| Tasigna |
| Taxol |
| Taxotere |
| Tecfidera capsule; delayed release |
| Tev-Tropin |
| Thalomid |
| Tracleer tablet |
| Tykerb |
| Tysabri |
| Tyvaso solution; inhalation |
| Tyzeka |
| Valtropin |
| Vectibix |
| Velcade |
| Veletri injection |
| Ventavis solution; inhalation |
| Victrelis |
| Vidaza |
| Viekira Pak |
| Viread |
| Visudyne |
| Xalkori |
| Xeloda |
| Xofigo |
| Xolair |
| Xtandi |
| Yervoy |
| Zaltrap |
| Zanosar |
| Zelboraf |
| Zorbtive |
| Zortress |
| Zykadia |
| Zytiga |
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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 Good Days Program |
(Requires Acrobat Reader) 
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