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Patient Assistance Information

 
 
 
Commitment to Care

1250 Bayhill Dr
Suite 300
San Bruno, CA 94066
Phone : (800) 521-7157 Ext option 2
Fax: (800) 683-7855
Eligibility
> The patient cannot have prescription insurance, be ineligible for government programs and meet income guidelines that are not disclosed. This program is only for patients taking the medication for Hepatitis C.
Who Can Apply
> The patient must call for a prescreening. The application is sent to the patient's home. The completed application can be faxed or mailed back. The patient is notified of eligibility for the program. The estimated timeline for acceptance is 7-10 business days. The medication is usually shipped within 7-10 business days.
Required
> The doctor needs to provide a prescription to the patient. The patient must provide information and proof of income.
Supply
> A 30-day supply is sent to the patient's home.
Ship To
> Physician's office or patient's home as indicated on application.
Note
> The patient must contact the company to arrange for refills. Every 6 months financial documentation is needed.
 
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.
 
Intron A (interferon alfa-2b recombinant)
Peg-Intron (peginterferon alfa-2b)
Rebetol (ribavirin)
Temodar (temozolomide)