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Velcade Reimbursement Assistance Program
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PO Box 52100
Phoenix, AZ 85072
Phone
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866-835-2233
Fax:
800-891-9843
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Eligibility
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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
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Anyone interested call for an application or download one. |
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Required
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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. |
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Supply
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Up to 4 vials |
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Ship To
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Doctor's office |
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Note
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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. |
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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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| Velcade |
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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 |
(Requires Acrobat Reader) 
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