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COMPASS Program

This program provides brand name medications at no or low cost

Provided by: Horizon Pharma USA, Inc.


TEL: 877-305-7704


FAX: 877-305-7706
Languages Spoken:

English

Program Website

 

Program Applications and Forms

COMPASS Program Enrollment Form

COMPASS Program Enrollment Form (Spanish)

 

Medications

  • Actimmune injection (interferon gamma-1b)
 

Eligibility Requirements   

Insurance Status Must not have any insurance or be eligible for state or federal funded healthcare
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call
Receiving Faxed to Doctor's office
Returning Fax or mail from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 72 hours
   

Medication

Amount/Supply Amount requested is sent
Sent To Doctor's office or specific site
Delivery Time Shipped overnight
Refill Process Automatically sent out
Limit Varies
Re-application New enrollment every 12 months
   

Additional Information

Patient must enroll in the COMPASS Program before applying.

This program provides Reimbursement and has a Copay Assistance Program.


Updated October 03, 2017


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Good Days Program

This is a copay assistance program

Provided by: Good Days from CDF

Attn: Enrollment
6900 Dallas Parkway
Suite #200
Plano, TX 75024

TEL: 877-968-7233


FAX: 214-570-3621
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Good Days Program Patient Enrollment Application (pages: 3-5)

Good Days Program Enrollment Information Pages (pages: 1 & 2)

 

Medications

  • Actimmune (interferon gamma-1b)
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax, mail or submit online
Doctor's Action Give prescription to patient
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Must re-enroll at end of calendar year
   

Additional Information

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.
Updated July 14, 2017


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Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • Actimmune (interferon gamma-1b)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

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.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.


Updated June 29, 2017


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COMPASS Sharps Container Program

Provided by: Horizon Pharma USA, Inc.


TEL: 877-305-7704


Languages Spoken:

English

Program Website

 

Program Applications and Forms

COMPASS Sharps Container Program: Contact program

 

Medications

  • Actimmune disposal container (container for actimmune sharps)
 

Eligibility Requirements   

Insurance Status Not applicable
Those with Part D Eligible? Not applicable
Income Not applicable
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident
   

Application

Obtaining Not specified
Receiving Not specified
Returning Not specified
Doctor's Action Not specified
Applicant's Action Call
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply 1 Container
Sent To Patient's home
Delivery Time Not specified
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information

The COMPASS program will provide patients with a sharps container with a return label for easy disposal of used syringes at no cost to the patients.


Updated September 15, 2017