Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Patient Access Network Foundation (PAN)This is a copay assistance program @if> |
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Provided by: Patient Access Network Foundation |
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PO Box 221858 TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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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 |
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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 |
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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 |
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*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. |
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Updated June 29, 2017 |