888-762-6436

The patient must have no insurance. meet income guidelines that are not disclosed.  The patient must also reside in the US. For those products administered pursuant to a physician office visit (including Aranesp, Epogen, Neupogen, Neulasta, and Vectibix), patients are enrolled through their provider (physician office or hospital facility). The provider must complete a Sponsor Enrollment Form (Form A) and will also facilitate completion of the Patient Enrollment Form (Form B). These medicines are on a replacement basis, so Form C (Product Request Form- Replacement) should be used. For Sensipar and Nplate, patients can enroll directly with The Safety Net Foundation by completing the Patient Enrollment Form (Form B) and Form C (Prescription Form- Prospective)

The doctor or patient can call to request an application. The application will be faxed out. The completed application must be faxed back.  The doctor is notified of acceptance or denial.  The medication is sent within 30 days of acceptance.

The doctor must fill out a section and sign the application. The patient must also complete, sign the application and attach proof of income.

Up to a 30-day supply is sent to the doctor's office.  Once a year a new application with financial documentation is needed.

877-977-9118 ext. 10184

Individual eligibility and level of financial support is determined on a case by case basis.  Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The Co-Pay Navigator is a full service program to help patients seek funding assistance for the co-pay portion of their required medications. There is no charge for this service. Physicians/physicians' offices may submit an application online at the website indicated above, or fax information as directed below.

The physician/physician's office should fax the prescription, diagnosis, patient demographics and any insurance information to 866-418-2650 Attn: Sandy/Funding.  A Patient Care Coordinator will contact the patient within 24-48 business hours.     

Will be discussed with the patient and physician after the initial request to the program is received. 

Not applicable.

800-675-8416

Applicants with insurance are eligible. The Foundation considers an individual's financial, medical, and insurance situation when determining who is eligible for assistance. Families with incomes below 400% of the Federal Poverty Level may qualify. Cost of living in a particular city or state is also taken into account. Medication must be used for medically appropriate condition. The patient must also reside in the US. 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.

Anyone can call to get the application sent out or it may be completed online. The application is sent out or it may be completed online.     

Not applicable.

Not applicable.