| Insurance Status |
Determined case by case |
| Those with Part D Eligible? |
Yes |
| Income |
Not disclosed |
| Diagnosis/Medical Criteria |
Must have MS |
| US Residency Required? |
Must be citizen or legal resident |
|
| Obtaining |
Call |
| Receiving |
Sent to the patient's home |
| Returning |
Fax |
| Doctor's Action |
Complete section, sign |
| Applicant's Action |
Program will contact patient for information |
| Decision Communicated |
Patient notified |
| Decision Timeframe |
Not specified |
|
| Amount/Supply
| Up to a 30 or 90 day supply |
| Sent To |
Patient's home |
| Delivery Time |
1-3 business days |
| Refill Process |
Patient contacts pharmacy |
| Limit |
Not specified |
| Re-application |
New application yearly |
|
