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

Program 1 of 2.
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Updated March 06, 2014
Crixivan

SUPPORT Program for Crixivan

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

Provided by: Merck & Company, Inc.

SUPPORT Program
PO Box 305
San Bruno,CA 94066

TEL: 800-850-3430


ALT PHONE:
FAX: 866-410-1913
Languages Spoken:

English

Program Website
 

Patient Assistance Applications

HIV Common Application; Merck & Company (Crixivan)

SUPPORT Program for Crixivan Application

SUPPORT Program for Crixivan Application (Spanish)

 

Medications

  • Crixivan Capsule 200mg 333mg, 400mg (indinavir)
 

Eligibility Requirements

Insurance Status May have insurance
Those with Part D Eligible? Considered on exception basis
Income At or below 500% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must live in the US and have prescription from US licensed doctor
   

Application

Obtaining Call or download
Receiving Sent to doctor or patient
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
   

Medication

Amount/Supply Varies
Sent To Doctor's office, pharmacy or patient's home
Delivery Time Within 10 days
Refill Process Automatically sent out
Limit Not specified
Re-application New application yearly
   

Additional Information

Insurance benefits, claims assistance and/or other reimbursement help is offered. Exceptions to guidelines considered.

This Program participates in the CPAPA. This single common application allows uninsured HIV-positive individuals with low incomes to use one application to apply for multiple assistance programs.

IMPORTANT: Send completed CPAPA to the corresponding addresses listed for each company.



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

Program 2 of 2. Updated January 30, 2014
Crixivan

Patient Access Network Foundation

This is a copay assistance program.

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


ALT PHONE:
FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website
 

Patient Assistance Applications

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • Crixivan Capsule 200mg, 400mg (indinvair sulfate)
 

Eligibility Requirements

Insurance Status Must have insurance
Those with Part D Eligible? Determined case by case
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside and receive treatment in US
   

Application

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
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

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 and the medication for which you are seeking assistance must treat the disease directly.