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

OneSource Treatment Support (Soliris)

This program provides brand name medications at no or low cost

Provided by: Alexion Pharmaceuticals, Inc.

100 College St
New Haven, CT 06510

TEL: 888-765-4747


FAX: 800-420-5150
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

OneSource Enrollment and Authorization Form (Soliris)

OneSource Treatment Support Brochure (Soliris)

 

Brand Name Medications Covered

 
  • Soliris injectable; iv
 

Generic Name

 
  • eculizumab injectable; iv
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Determined case by case
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Not specified
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Fax or mail
Doctor's Action Doctor is required to submit medical information for screening
Applicant's Action Complete authorization and release forms available on website
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Determined on a case by case basis
Limit Not specified
Re-application Not specified
   

Additional Information

Insurance benefits, claims assistance, or other reimbursement help is offered.

This program also provides copay assistance.


Updated October 11, 2017