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Crixivan

SUPPORT Program for Crixivan

This program provides brand name medications at no or low cost

Provided by: Merck Sharp & Dohme Corp., a subsidiary of Merck & Co.

SUPPORT Program
PO Box 220702
Charlotte, NC 28222-0702

TEL: 800-850-3430


FAX: 866-410-1913
Languages Spoken:

English

Program Website

 

Program Applications and Forms

SUPPORT Program for Crixivan Enrollment Form

SUPPORT Program Brochure

HIV Common Application: Merck & Company (CRIXIVAN)

 

Medications

  • Crixivan capsule (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 and sign
Applicant's Action Complete section and 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.


Updated November 08, 2016


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Crixivan

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

 Patient Access Network Foundation (PAN) Application: Contact program

Patient Access Network Foundation (PAN) Provider Brochure

Patient Access Network Foundation (PAN) Patient Brochure

 

Medications

  • Crixivan (indinavir sulfate)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
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

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

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.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.


Updated August 02, 2016