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

Actelion Pathways

This program provides brand name medications at no or low cost

Provided by: Actelion Pharmaceuticals US, Inc.


TEL: 866-228-3546


FAX: 866-279-0669
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

Actelion Pathways Enrollment Form: Contact program

 

Brand Name Medications Covered

 
  • Opsumit tablet
  • Veletri injection
  • Tracleer tablet
  • Ventavis solution; inhalation
  • Uptravi
 

Generic Name

 
  • bosentan tablet
  • macitentan tablet
  • epoprostenol sodium injection
  • selexipag
  • iloprost solution; inhalation
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Must be used for on-label diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Applicant must call for prescreening
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
   

Medication

Amount/Supply Up to 30 day supply
Sent To Doctor's office or patient's home
Delivery Time 1-3 business days
Refill Process Patient or Doctor must contact company
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

Opsumit and Tracleer: Pharmacies that supply inpatient use, Females, Prescribing Physician and Healthcare Providers must enroll in the Risk Evaluation and Mitigation Strategy (REMS) Program.

The company may also provide copay assistance.


Updated July 19, 2017