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Updated February 07, 2014
Lantus SoloSTAR Pen

Sanofi Patient Connection Program

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

Provided by: Sanofi-Aventis U.S. LLC

PO Box 222138
Charlotte, NC 28222-2138

TEL: 888-847-4877


ALT PHONE: 800-221-4025
FAX: 888-847-1797
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website
 

Patient Assistance Applications

Sanofi-Aventis Patient Assistance Program

 

Medications

  • Lantus SoloSTAR Pen Injection 300 units/3mL (insulin glargine)
 

Eligibility Requirements

Insurance Status Must have no prescription insurance, be ineligible for any state and federal programs
Those with Part D Eligible? Considered on exception basis
Income At or below 500% of FPL for oncology products and at or below 250% of FPL for all other products
Diagnosis/Medical Criteria Medically appropriate condition
US Residency Required? Yes and have social security number
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Mail or fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 2-4 business days
Refill Process Reorder form needs to be submitted
Limit None
Re-application New application, new documentation yearly
   

Additional Information

Negative decision may be appealed. Insurance benefits, claims assistance and/or other reimbursement help is offered. Exceptions to guidelines considered.

Patients who do not file taxes must either request a 4506-T form from the IRS, submit proof of benefits received (such as Social Security Earning Statement), or submit W2's of the person who is supporting them financially.

Healthcare provider must contact the Program for REORDER FORMS.

*On most medications, excluding Lovenox, patients with Medicare Part D may be considered if they are not eligible for Low Income Subsidy, and they have spent at least 5% of annual household income on out-of-pocket costs for medications.
Contact program for Spanish application.