| Insurance Status |
May have insurance |
| Those with Part D Eligible? |
Yes |
| Income |
At or below 300% of FPL |
| Diagnosis/Medical Criteria |
Not required |
| US Residency Required? |
Must reside in the US |
|
| Obtaining |
Call, download or apply online |
| Receiving |
Faxed or mailed |
| Returning |
Fax or E-Prescribe online |
| Doctor's Action |
Give prescription to patient |
| Applicant's Action |
Complete section, sign |
| Decision Communicated |
Medications sent if accepted. If denied patient and Doctor notified |
| Decision Timeframe |
Usually same day |
|
| Amount/Supply
| Varies |
| Sent To |
Doctor's office or patient's home |
| Delivery Time |
Not specified |
| Refill Process |
Company contacts patient to arrange |
| Limit |
Only limited by manufacturer's guidelines |
| Re-application |
New application yearly |
|
