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Program 1 of 6.
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Neulasta

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HealthWell Foundation Copay Program

This is a copay assistance program.

Provided by: HealthWell Foundation

PO Box 4133
Gaithersburg, MD 20897-7811

TEL: 800-675-8416


FAX: 800-282-7692
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

 HealthWell Foundation Copay Program: Contact program

 

Medications

  • Neulasta (pegfilgrastim)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside in the US
   

Application

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Not applicable
Sent To Varies
Delivery Time Not specified
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.
Updated May 10, 2016


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Neulasta

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Patient Access Network Foundation (PAN)

This is a copay assistance program.

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

 Patient Access Network Foundation (PAN) Application: Contact program

Patient Access Network Foundation (PAN) General Brochure

 

Medications

  • Neulasta (pegfilgrastim)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.




Updated April 12, 2016


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Neulasta

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Diplomat's Co-Pay Assistance Navigator Program

This is a copay assistance program.

Provided by: Diplomat Specialty Pharmacy

ATTN: FUNDING ASSISTANCE
4100 S Saginaw Street
Flint, MI 48507

TEL: 877-977-9118 ext. 89864


FAX: 810-282-0176
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Diplomat Request of Financial Assistance Form

 

Medications

  • Neulasta syringe (pegfilgrastim)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Yes
Income Determined case by case
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Yes
   

Application

Obtaining Call or complete online
Receiving Faxed, mailed or complete online
Returning Fax or mail
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
   

Medication

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 copay 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


Updated April 26, 2016


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Program 4 of 6.
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Neulasta

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Amgen FIRST STEP Co-Pay Support

This is a copay assistance program.

Provided by: Amgen, Inc.


TEL: 888-657-8371


FAX: 888-653-2972
Languages Spoken:

English

Program Website

 

Program Applications and Forms

 Amgen FIRST STEP Co-Pay Support: Contact program

 

Medications

  • Neulasta syringe (pegfilgrastim)
 

Eligibility Requirements   

Insurance Status Must be commercially insured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be citizen
   

Application

Obtaining Patient/Doctor must call to register and enroll
Receiving Not applicable
Returning Not applicable
Doctor's Action Enroll in program, complete form and obtain patient consent
Applicant's Action Call to enroll
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not applicable
Sent To Card sent to doctor's office or to patient's home
Delivery Time Not specified
Refill Process Doctor/Doctor's office must contact the Program
Limit None
Re-application Card is valid for the enrolled patient's entire course of treatment
   

Additional Information

Health Care Providers must enroll in the program prior to processing the Amgen FIRST STEP Program Cards

The card is valid for the patient's entire course of treatment. Eligible patients may re-enroll at any time a new course of treatment is initiated.


Updated December 11, 2015


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The Safety Net Foundation

This program provides medication at no cost.

Provided by: Amgen, Inc.

PO Box 18769
Louisville, KY 40261-7821

TEL: 888-762-6436


FAX: 866-549-7239
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

 The Safety Net Foundation Application: Contact program

 

Medications

  • Neulasta syringe (pegfilgrastim)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Varies
Income At or below 500% of FPL
Diagnosis/Medical Criteria *See Additional Information section below
US Residency Required? Yes, must have lived in the US or its territories for 6 months or longer.
   

Application

Obtaining Call or download
Receiving Mailed or downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication

Amount/Supply Amount requested is sent
Sent To Address of shipment varies by medication
Delivery Time Varies
Refill Process Determined on a case by case basis
Limit Not specified
Re-application Varies
   

Additional Information

Please visit www.SafetyNetFoundation.com for more information.

* Diagnosis is required if patient has insurance.


Updated May 03, 2016


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 6 of 6.
 

Neulasta

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Neulasta Onpro Sharps Container Disposal Program

Provided by: Amgen, Inc.


TEL: 844-696-3852


Languages Spoken:

Program Website

 

Program Applications and Forms

 Sharps Mail-Back Program for Neulasta: Contact program

 

Medications

  • Neulasta disposal container (container for Neulasta)
 

Eligibility Requirements   

Insurance Status Not specified
Those with Part D Eligible? Not specified
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Not specified
   

Application

Obtaining Call or enroll online
Receiving Not specified
Returning Not specified
Doctor's Action Not applicable
Applicant's Action Call or enroll online
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply 1 Container
Sent To Patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit Not specified
Re-application Not specified
   

Additional Information


Updated April 29, 2016