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

Program 1 of 1.  Updated April 05, 2013 Back | Print Page

This program provides brand name medications at no or low cost.

Sigma-Tau Patient Assistance Program and Reimbursement Services

Provided by:


Sigma-Tau Pharmaceuticals, Inc.
4511 Singer Court
Suite 210
Chantilly, VA 20151

TEL: 800-490-3262


ALT PHONE:
FAX: 866-694-2544
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Abelcet IV Suspension  (amphotericin B lipid complex)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no coverage for the requested medication, be ineligible for federal or state programs
Those with Part D Eligible? Not specified
Income At or below 300% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? No residency requirements
Obtaining Call
Receiving Mailed, faxed or emailed
Returning Mail, fax or email
Doctor's Action Complete section, sign, attach prescription and include the DEA and state license number
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Health care provider notified via fax
Decision Timeframe 3-5 business days
Amount/Supply Up to 3 months supply
Sent To Doctor's office or infusion site
Delivery Time Shipped next business day
Refill Process Patient or Doctor must contact company
Limit None
Re-application New application every 3 months

Additional Information:

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



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