|
This program provides brand name medications at no or low cost.
|
| Pharmaceutical Company |
Enzon |
| Program Name |
Enzon Patient Assistance Program |
| Program Address |
PO Box 8013
Somerville, NJ 08876 |
| Phone Number |
800-345-2252, opt 3
|
| Fax Number |
888-625-6587 |
| Medications on Program |
Abelcet IV Suspension (amphotericin b lipid complex)
|
| Application Forms |
Enzon Patient Assistance Program
|
On-line Application
|
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 prescription coverage for the requested medication and have an income at or below 200% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. Patients who eligible for Medicare, Part D but did not enrolled may still be eligible for this program. There is an insurance verification component to the program, as well as an appeals process.
|
| Application Process |
The patient or doctor should call for an application. The application will be faxed out. The completed application can be faxed or mailed back.
Notification of acceptance or denial is sent to whomever started the application process. The estimated timeline is 3-5 business days. The medication is shipped the next business day.
|
| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
|
| Program Details |
The medication is sent to either the doctor's office, or a specific site (clinic, hospital, infusion site etc.) A new prescription is needed for each refill. Once a year a new application with financial documentation is needed.
|
| Last Updated |
November 09, 2009 |
