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

Daraprim

Daraprim Direct Program

Provided by: Vyera Pharmaceuticals, LLC


TEL: 877-258-2033


ALT PHONE: 844-267-3323
FAX: 877-241-1365
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Daraprim Direct Enrollment Form

Daraprim Brochure

 

Medications

  • Daraprim tablet (pyrimethamine)
 

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be US citizen or legal entrant
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Within 24-48 hours
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Once approved; within 2 business days
Refill Process Company contacts patient to arrange
Limit Not specified
Re-application Not specified
   

Additional Information


Updated February 22, 2018