Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Updated October 23, 2014
 

Epogen

Diplomat's Co-Pay Assistance Navigator Program

This is a copay assistance program.

Provided by: Diplomat Specialty Pharmacy

ATTN: FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


ALT PHONE:
FAX: 810-282-0176
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Diplomat Request of Financial Assistance Form

 

Medications

  • Epogen Injection dosage varies (epoetin alfa)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Fax or mail
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
   

Medication

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 copay 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



Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2. Updated December 15, 2014
 

Epogen

The Safety Net Foundation

This program provides medication at no cost.

Provided by: Amgen, Inc.

PO Box 18769
Louisville, KY 40261-7821

TEL: 888-762-6436


ALT PHONE:
FAX: 866-549-7239
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

 The Safety Net Foundation: Contact program

 

Medications

  • Epogen Injection (for dialysis only) dosage varies (epoetin alfa)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Varies
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 US Virgin Islands
   

Application

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 and sign
Decision Communicated Doctor notified
Decision Timeframe 2-5 business days
   

Medication

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

Please visit www.SafetyNetFoundation.com for more information