Program

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Program 1 of 2 Scroll down to see them all.

This program provides brand name medications at no or low cost.
Pharmaceutical Company	EMD Serono
Program Name	MS Lifelines
Program Address
Phone Number	877-447-3243 option 4
Fax Number	866-227-3243
Medications on Program	Rebif Subcutaneous (interferon beta 1a)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Applicants with Medicare Part D and Medicaid are not eligible, those with other types of insurance are eligible. The patient must also have MS. The patient must also be a US resident. This program does not use financial guidelines or an application for the first year of enrollment. It aims to reduce the copay for Rebif to under $50. An application process is used for the second year of enrollment. For the second year, see the guidelines below.
Application Process	The patient must call for a prescreening. The application is sent to the patient. The completed application must be mailed back. The patient is notified of eligibility for the program. The estimated timeline for acceptance is 7-10 business days.
Application Requirements	The doctor/doctor's office must fax a prescription to the company. The patient must fill out a section, sign the application and attach proof of income.
Program Details	The medication is sent to the patient's home. The company contacts the patient to arrange for refills. Once a year a new application with financial documentation is needed.
Last Updated	August 12, 2009

Program 2 of 2.

This program provides help in applying for assistance with the cost of this drug.
Pharmaceutical Company	Diplomat Specialty Pharmacy
Program Name	Diplomat's Co-Pay Assistance Navigator Program
Program Address	Attn: Funding Department 2029 S. Elms Rd., Suite D, Swartz Creek, MI 48473
Phone Number	877-977-9118 ext. 10184
Fax Number	866-418-2650
Medications on Program	Rebif Subcutaneous (interferon beta 1a)
Application Forms	Not Applicable
On-line Application	No on-line application available at this time
Web Site	Click to go to program's web site
Eligibility Guidelines and Notes	Individual eligibility and level of financial support is determined on a case by case basis. Medical diagnosis necessary for this program is not specified. US residency requirements are not specified. The Co-Pay Navigator is a full service program to help patients seek funding assistance for the co-pay portion of their required medications. There is no charge for this service. Physicians/physicians' offices may submit an application online at the website indicated above, or fax information as directed below.
Application Process	The physician/physician's office should fax the prescription, diagnosis, patient demographics and any insurance information to 866-418-2650 Attn: Sandy/Funding. A Patient Care Coordinator will contact the patient within 24-48 business hours.
Application Requirements	Will be discussed with the patient and physician after the initial request to the program is received.
Program Details	Not applicable.
Last Updated	August 05, 2009