Program

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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	Amgen & Wyeth
Program Name	Encourage Foundation
Program Address	PO Box 4133 Gaithersburg, MD 20879
Phone Number	800-282-7752
Fax Number	888-508-8083
Medications on Program	Enbrel Injection (etanercept)
Application Forms	Encourage Foundation Patient Assistance Program
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	The patient must have no insurance. meet income guidelines that are not disclosed. Medical diagnosis necessary for this program is not specified. The patient must also reside in the US. Mon-Fri 8a-8pm EST. To enroll in the foundation, patients must complete a Patient Enrollment Form (Form B) and submit supporting income documentation. The patient’s physician must validate and sign the Prescription Form (Form A).
Application Process	Not applicable.
Application Requirements	The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
Program Details	The amount requested is sent to the patient's home. The company contacts the patient to arrange for refills. Once a year the application process must be repeated.
Last Updated	September 22, 2009

Program 2 of 2.

This program provides help in applying for assistance with the cost of this drug.
Pharmaceutical Company	Diplomat Specialty Pharmacy
Program Name	Diplomat's Co-Pay Assistance Navigator Program
Program Address	Attn: Funding Department 2029 S. Elms Rd., Suite D, Swartz Creek, MI 48473
Phone Number	877-977-9118 ext. 10184
Fax Number	866-418-2650
Medications on Program	Enbrel 1 (etanercept)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Individual eligibility and level of financial support is determined on a case by case basis. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The Co-Pay Navigator is a full service program to help patients seek funding assistance for the co-pay portion of their required medications. There is no charge for this service. Physicians/physicians' offices may submit an application online at the website indicated above, or fax information as directed below.
Application Process	The physician/physician's office should fax the prescription, diagnosis, patient demographics and any insurance information to 866-418-2650 Attn: Sandy/Funding. A Patient Care Coordinator will contact the patient within 24-48 business hours.
Application Requirements	Will be discussed with the patient and physician after the initial request to the program is received.
Program Details	Not applicable.
Last Updated	August 05, 2009