800-830-9049

Patient must not have insurance or the medication is not covered by the insurance. The patient must meet the required income guideline of 200% of the FPL. Medical diagnosis necessary for this program is not specified. The patient must also be a US resident. If the patient is eligible to enroll in a Medicare prescription drug plan and has an income below 150% FPL, they must document that s/he doesn't qualify for a Medicare drug subsidy. This program is not accepting new patients at this time.

With the patient's permission, anyone concerned can call for an application. The application is sent to either the doctor or the patient. The completed application must be faxed or mailed from the doctor's office.  Both the patient and the health care professional are notified in writing of acceptance or denial. The decision is usually made within 2 weeks. The medication is shipped out within 5-7 business days.

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.

Up to a 90-day supply is sent to the doctor's office or the patient's home. The patient or doctor must contact the company for refills. Once a year a new application with financial documentation is needed.