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 June 12, 2013 Back | Print Page

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

Sanofi Patient Connection Program

Provided by:


Sanofi
PO Box 222138
Charlotte, NC 28222-2138

TEL: 888-847-4877


ALT PHONE:
FAX: 888-847-1797
 Program Website

Languages Spoken: English, Spanish, Others By Translation Service

Patient assistance
applications

 

Medications

Lovenox Injection 30mg/0.3ml, 40mg/0.4ml (enoxaparin sodium)

Eligibility Requirements

APPLICATION

MEDICATION
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
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 proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
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:

As of 12/31/2012 Eloxatin will no longer be available to new applicants. Those already enrolled will be serviced through the patient's 12 month eligibility period but drug replacement will only last for 6 months after 2012.

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

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 of annual household income out of pocket on medications.

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), or submit W2's of the person who is supporting them financially.

Healthcare provider must contact the Program for REORDER FORMS
Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.

Program 2 of 2.  Updated January 15, 2013 Back | Print Page

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

Lovenox Reimbursement Services and Patient Assistance Program

Provided by:


Sanofi-Aventis
P.O. Box 8256
Somerville NJ, 08876

TEL: 888-847-4877


ALT PHONE:
FAX: 888-847-1797
 Program Website

Languages Spoken: English, Others By Translation Service

Patient assistance
applications

 

Medications

Lovenox Injection 30mg/0.3ml, 40mg/0.4ml, 60mg/0.6ml, 80mg/0.8ml, 100mg/1ml. 120mg/0.8ml, 150mg/1ml (enoxaparin sodium)

Eligibility Requirements

APPLICATION

MEDICATION
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Determined case by case
Income At or below 250% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
Obtaining Call
Receiving Faxed
Returning Fax
Doctor's Action Complete section, sign
Applicant's Action Complete section, sign
Decision Communicated Hospital notified of acceptance or denial
Decision Timeframe Within 48 hours
Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 5-7 business days, call for other options
Refill Process Not applicable
Limit Not specified
Re-application New application every 3 months

Additional Information:

This program has both an insurance verification component and a patient assistance program but only one form. There is an appeals process for those with insurance who cannot afford the co-pays.



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