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

Program 1 of 5   Scroll down to see them all.  Updated May 22, 2013 Back | Print Page

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

Celgene Patient Support

Provided by:


Celgene Corporation
300 Connell Drive, 7th Floor
Berkeley Heights, NJ 07922

TEL: 800-931-8691


ALT PHONE:
FAX: 800-822-2496
 Program Website

Languages Spoken: English, Spanish

Patient assistance
applications

 

Medications

Abraxane Injectable supsension 100mg (paclitaxel protein-bound particles for injectable suspension)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Not required
US Residency Required? Yes, with prescription from US doctor
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Patient and Doctor notified of acceptance
Decision Timeframe Within 24-48 hours
Amount/Supply Up to 1 month supply
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient or Doctor must contact company
Limit None
Re-application Company contacts patient about reapplying

Additional Information:


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

Program 2 of 5   Scroll down to see them all.  Updated May 22, 2013 Back | Print Page

This is a copay assistance program.

Celgene Co-pay Assistance Program

Provided by:


Celgene Corporation
Celgene Patient Support
110 Allan Road
Basking Ridge, NJ 07920

TEL: 800-931-8691


ALT PHONE:
FAX: 800-822-2496
 Program Website

Languages Spoken: English

Patient assistance
applications


 

Medications

Abraxane Injectable suspsension 100mg (paclitaxel protein-bound particles for injectable suspension)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income Gross annual household income at or below $100,000
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
Obtaining Applicant must call for prescreening
Receiving Patient is contacted if eligible after phone screening
Returning Not specified
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Program will contact patient for information
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 24-48 hours
Amount/Supply Not applicable
Sent To Not applicable
Delivery Time Not applicable
Refill Process Not applicable
Limit Not specified
Re-application Not specified

Additional Information:

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

Program 3 of 5   Scroll down to see them all.  Updated March 25, 2013 Back | Print Page

This is a copay assistance program.

Diplomat's Co-Pay Assistance Navigator Program

Provided by:


Diplomat Specialty Pharmacy
4100 S Saginaw St.
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


ALT PHONE:
FAX: 810-282-0176
 Program Website

Languages Spoken: English

Patient assistance
applications


 

Medications

Abraxane Injectable Suspension 100mg (paclitaxel protein-bound particles for injectable suspension)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Mail or fax
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign and provide annual income information. Proof of income may be request by program at any time
Decision Communicated Patient and/or Doctor are notified
Decision Timeframe Within 1-2 business days
Amount/Supply Amount requested is sent
Sent To Patient's home
Delivery Time Once approved; within 2 business days
Refill Process Company contacts patient to arrange
Limit Varies per medication
Re-application Determined case by case

Additional Information:

Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the co-pay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie 
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 4 of 5   Scroll down to see them all.  Updated May 10, 2013 Back | Print Page

This is a copay assistance program.

HealthWell Foundation Copay Program

Provided by:


HealthWell Foundation
P.O Box 4133
Gaithersburg, MD 20897-7811

TEL: 800-675-8416


ALT PHONE:
FAX: 800-282-7692
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

Abraxane Injectable Suspension 100mg (paclitaxel protein-bound particles for injectable suspension)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Less than 400% of FPL.may qualify. Cost of living in a particular city or state is considered.
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside in the US
Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
Amount/Supply Not applicable
Sent To
Delivery Time
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months

Additional Information:

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 5 of 5.  Updated February 12, 2013 Back | Print Page

This is a copay assistance program.

Patient Access Network Foundation

Provided by:


Patient Access Network Foundation
PO Box 221858
Charlotte, NC 28222

TEL: 866-316-7263


ALT PHONE:
FAX: 866-316-7261
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications


 

Medications

Abraxane Injectable Suspension 100mg (paclitaxel protein-bound particles for injectable suspension)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have insurance
Those with Part D Eligible? Yes
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside and receive treatment in US
Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved ; shipped same day.
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months

Additional Information:

Call for most recent medications as the list is subject to change.



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