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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Actelion Pharmaceuticals |
| Program Name |
Ventavis Patient Assistance Program |
| Program Address |
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| Phone Number |
877-483-6828, opt 2
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| Fax Number |
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| Medications on Program |
Ventavis Inhalation Solution (iloprost)
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| Application Forms |
Ventavis Program Enrollment Form
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient must have no insurance and meet income guidelines that are not disclosed. The patient must also be taking the medication for an on-label diagnosis. The patient must also be a US resident. If no coverage is identified, patient will be referred to the Ventavis Patient Assistance Program for further screening on income, residency, and diagnosis. The application is then sent to the patient for verification of income and residency.
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| Application Process |
Anyone requesting assistance can call to get an enrollment form sent out, or download it from the website. The enrollment form is faxed out. The completed application can be faxed or mailed back.
Both the patient and doctor are notified of acceptance into the program. The decision is usually made within 24-48 hours. The medication is shipped within 3-5 business days.
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| Application Requirements |
The doctor must fill out and sign the enrollment form. The patient must fill out a section, sign the application and attach proof of income and denial letter from Medicaid.
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| Program Details |
Up to a 30-day supply is sent to the doctor's office or the patient's home. The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.
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| Last Updated |
April 27, 2009 |
