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

Program 1 of 4   Scroll down to see them all.  Updated May 24, 2013 Back | Print Page

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

Novartis Oncology Patient Assistance Program

Provided by:


Novartis Pharmaceuticals
Novartis Patient Assistance Program
PO Box 66978
St. Louis, MO 63166-6978


TEL: 800-277-2254


ALT PHONE:
FAX: 855-817-2711
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

Gleevec Tablet 100mg, 400mg (imatinib)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage
Those with Part D Eligible? Considered on exception basis
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
Obtaining Doctor must ask for service request
Receiving Faxed or mailed
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Not specified
Decision Timeframe Not specified
Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit None
Re-application New application yearly

Additional Information:

Eligibility determined on a case-by-case basis.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 4   Scroll down to see them all.  Updated May 24, 2013 Back | Print Page

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

Novartis Patient Assistance Now Oncology (PANO)

Provided by:


Novartis Pharmaceuticals
Novartis Patient Assistance Program
PO Box 66978
St. Louis, MO 63166-6978



TEL: 800-282-7630


ALT PHONE:
FAX: 888-891-4924
 Program Website

Languages Spoken: English

Patient assistance
applications

 

Medications

Gleevec Tablet 100mg, 400mg (imatinib)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance; must be experiencing financial difficulty
Those with Part D Eligible? Determined case by case
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes
Obtaining Doctor must ask for service request
Receiving Faxed or mailed
Returning Mail or fax
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Not specified
Decision Timeframe Not specified
Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit None
Re-application New application yearly

Additional Information:

Eligibility determined on a case-by-case basis.
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 3 of 4   Scroll down to see them all.  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

Gleevec Tablet 100mg (imatinib)

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

Program 4 of 4.  Updated May 10, 2013 Back | Print Page

This is a copay assistance program.

HealthWell Foundation Copay Program

Provided by:


HealthWell Foundation
P.O Box 4133
Gaithersburg, MD 20897-7811

TEL: 800-675-8416


ALT PHONE:
FAX: 800-282-7692
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

Gleevec   (imatinib)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Less than 400% of FPL.may qualify. Cost of living in a particular city or state is considered.
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Must reside in the US
Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
Amount/Supply Not applicable
Sent To
Delivery Time
Refill Process Good for one year
Limit Not specified
Re-application New application every 12 months

Additional Information:

This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease.

Call for most recent medications as the list is subject to change.



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