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Patient Assistance Information

 
 
 
Velcade Reimbursement Assistance Program

PO Box 52100
Phoenix, AZ 85072
Phone : 866-835-2233
Fax: 800-891-9843
Eligibility
> This program provides brand name medications at no or low cost. Insurance requirements are determined on a case by case basis. Income requirements have not been disclosed for this program. Patient must reside in the US.
Who Can Apply
> Anyone interested call for an application or download one.
Required
> The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income. The application can be sent by fax or mail.
Supply
> Up to 4 vials
Ship To
> Doctor's office
Note
> his program will also help do research to find other sources of payment if the copay is too high. There is also a drug replacement program for patients who have insurance but have been denied coverage. The application must be sent in with a copy of the letter from the insurance company indicating that an appeal for coverage has been denied. Contact program for Spanish application.
 
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.
 
Velcade
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader