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

Angiomax Reimbursement and Patient Financial Assistance Program

This program provides brand name medications at no or low cost

Provided by: Medicines Company, The

8 Sylvan Way
Parsippany, NJ 07054

TEL: 800-756-6463


ALT PHONE: 800-388-1183
FAX: 800-759-4491
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Angiomax Reimbursement and Patient Financial Assistance Program Application

 

Medications

  • Angiomax injection; iv (bivalirudin)
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Representative from the hospital must call for an application or download it from the website
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Hospital contact or Dr must complete application and verify patient's financial situation
Applicant's Action Provide information and proof of income
Decision Communicated Doctor notified
Decision Timeframe 7-10 business days
   

Medication

Amount/Supply Up to 5 vials
Sent To Replacement sent to hospital
Delivery Time Within 6-8 weeks
Refill Process New application needed
Limit Maximum of 2 refills in one year
Re-application New application needed for each refill
   

Additional Information


Updated March 20, 2017