Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
 

Nestle HealthCare Nutrition Pediatric Patient Assistance Program

Provided by: Nestle HealthCare Nutrition, Inc.

Nestle HealthCare Nutrition, Inc.
Attn: Renae Simmons
2150 E. Lake Cook Road
Suite 800
Buffalo Grove, IL 60089

TEL: 800-422-2752


Languages Spoken:

English

Program Website

 

Program Applications and Forms

Nestle HealthCare Nutrition Pediatric Patient Assistance Program: Contact program

 

Medications

  • Alfamino Junior (medical food)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed product
Those with Part D Eligible? Yes, if product is not covered
Income At or below 200% of FPL
Diagnosis/Medical Criteria *See Additional Information section below
US Residency Required? Yes, and must be treated by US doctor
   

Application

Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section and sign
Decision Communicated Product sent if accepted. If denied patient notified
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Varies
Sent To Patient's home, unless otherwise noted
Delivery Time Within 2 weeks
Refill Process Not applicable
Limit Up to two years
Re-application New application yearly
   

Additional Information

Most products are intended for tube feeding. Some are oral nutritional supplements.

*Eligibility Criteria: The patient is 18 years of age or younger. Only patients whose sole or primary source of nutrition is the requested product are eligible (80% - 100% of the patients caloric needs are met by the product).

The product names listed above are trademarks of Societe des Produits Nestlé SA, Vevey, Switzerland.


Updated July 18, 2017