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Patient Assistance Information

Support Program

Phone : 855-847-9435
Fax: 855-847-9478
> Patient must have no insurance or no prescription coverage. Income requirements will be based on the Federal Poverty Level. Patients must have a medically appropriate condition/diagnosis and be a US resident.
Who Can Apply
> Patients or healthcare providers can call to have an application faxed or mailed.
> Doctors must complete a section of the application and sign. Patients must complete a section, sign, attach proof of income and other requested documentation.
> Not applicable
Ship To
> Not applicable
> This Company also offers a Reimbursement Program.
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.
Vibativ vial