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

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Kaleo Cares Patient Assistance Program (Auvi-Q)

This program provides brand name medications at no or low cost

Provided by: Kaleo, Inc


TEL: 877-302-8847


FAX: 800-943-1730
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Kaleo Cares Patient Assistance Program Enrollment Form (Auvi-Q)

Kaleo AffordAbility Direct Delivery Service FAQ (Auvi-Q)

 

Medications

  • Auvi-Q (epinephrine)
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No, must be ineligible
Income At or below 100% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be US citizen or legal entrant
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified by phone
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient's home
Delivery Time Within 48 hours
Refill Process Not specified
Limit Not specified
Re-application Not specified
   

Additional Information


Updated May 25, 2017