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

Program 1 of 2   Scroll down to see them all.  Updated January 15, 2013 Back | Print Page

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

The Safety Net Foundation

Provided by:


Amgen, Inc.
PO Box 18769
Louisville, KY 40261

TEL: 888-762-6436


ALT PHONE:
FAX: 866-549-7239
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

Epogen Injection (for dialysis only) 1 (epoetin alfa)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? No
Income Income Guidelines published on Program Website
Diagnosis/Medical Criteria Not applicable
US Residency Required? Must reside permanently in the US , Guam, Puerto Rico or U.S. Virgin Islands
Obtaining Call or download
Receiving Mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign
Decision Communicated Doctor notified
Decision Timeframe 2-5 business days
Amount/Supply Varies
Sent To Address of shipment varies by medication
Delivery Time Not specified
Refill Process Determined on a case by case basis
Limit Not specified
Re-application New application every 12 months

Additional Information:

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

Program 2 of 2.  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

Epogen Injection  (epoetin alfa)

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 



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