| 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. |
