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

Program 1 of 4   Scroll down to see them all.  Updated June 17, 2013 Back | Print Page

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

The Free Drug Program

Provided by:


Biogen Idec
5000 Davis Drive
PO Box 13919
Research Triangle Park
Morrisville, NC 27709


TEL: 800-456-2255


ALT PHONE:
FAX: 877-301-5140
 Program Website

Languages Spoken: English

Patient assistance
applications


 

Medications

  • Avonex  Im injection 30mcg (interferon beta-1a)
  • Avonex  Injection 30mcg (interferon beta 1a)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Relapsing form of MS
US Residency Required? Must reside in the US
Obtaining Applicant must call for prescreening
Receiving There is no application
Returning Not specified
Doctor's Action Fax in prescription
Applicant's Action Provide information and proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Not specified
Amount/Supply Not specified
Sent To Not applicable
Delivery Time Not specified
Refill Process Company contacts patient to arrange
Limit None
Re-application Company contacts patient about reapplying

Additional Information:

Patients will be referred to a financial assistance counselor. Decisions made on a case by case basis. Program assistance can range from a temporary need up to a 2 year enrollment period. For Avonex: up to a 90-day supply is sent to the doctor's office or the patient's home. For Tysabri: a one month supply is sent to the doctor's office or site of care for administration of the infusion.

Insurance benefits, claims assistance and/or other reimbursement help is offered.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 4   Scroll down to see them all.  Updated June 17, 2013 Back | Print Page

This is a copay assistance program.

Biogen Idec Copay Assistance Program

Provided by:


Biogen Idec
5000 Davis Drive
PO Box 13919
Research Triangle Park
Morrisville, NC 27709

TEL: 800-456-2255


ALT PHONE:
FAX: 877-301-5140
 Program Website

Languages Spoken:

Patient assistance
applications


 

Medications

  • Avonex  Injection 30mcg (interferon beta 1a)
  • Avonex  Powder for Injection 30mcg (interferon beta 1a)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income No limits
Diagnosis/Medical Criteria Relapsing form of MS
US Residency Required? Yes
Obtaining Applicant must call for prescreening
Receiving There is no application
Returning Not applicable
Doctor's Action Fax in prescription
Applicant's Action Provide information and proof of income
Decision Communicated Decision made during phone screening
Decision Timeframe Decision made during phone screening
Amount/Supply Not specified
Sent To Not applicable
Delivery Time Not specified
Refill Process Pharmacy contacts patient
Limit None
Re-application New application yearly

Additional Information:

Patients will be referred to a financial assistance counselor. Decisions made on a case by case basis. There may be an annual cap that limits the amount of assistance that you can receive over one year, based on income. For Avonex: up to a 90-day supply is sent to the doctor's office or the patient's home. For Tysabri: a one month supply is sent to the doctor's office or site of care for administration of the infusion. During conditional approval, medication will be covered as per program guidelines.

Insurance benefits, claims assistance and/or other reimbursement help is offered.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 4   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

  • Avonex  Injection 30mcg (interferon beta 1a)
  • Avonex  Powder for Injection 30mcg (interferon beta 1a)

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 4.  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

Avonex Injection 30mcg (interferon beta-1a)

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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