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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Daiichi Sankyo |
| Program Name |
Daiichi Sankyo Pharma Open Care Program |
| Program Address |
PO Box 8409
Somerville, NJ 08876 |
| Phone Number |
866-268-7327, ext 1
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| Fax Number |
866-217-7171 |
| Medications on Program |
Evoxac Capsules 30mg (cevimeline)
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| Application Forms |
Daiichi Sankyo Open Care Program
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On-line Application
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No on-line application available at this time |
| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient can have no public or private prescription insurance and have an income at or below 200% of the Federal Poverty Level. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. If the patient is eligible for Medicare Part D but did not enroll then they may be eligible for this program.
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| Application Process |
With the patient's permission, anyone concerned can call for an application. The application will be faxed out. The completed application can be faxed or mailed back.
The patient is notified of denial in writing. Allow 2 weeks for processing and delivery of medication.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a prescription. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
Up to a 90-day supply is sent to the doctor's office. A new application with new prescription is needed for refills. Once a year a new application with financial documentation is needed.
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| Last Updated |
October 27, 2009 |
