Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 4.
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Updated December 11, 2014
 

Revlimid

Celgene Patient Support

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

Provided by: Celgene Corporation

400 Connell Drive
5th Floor
Berkeley Heights, NJ 07922

TEL: 800-931-8691


ALT PHONE:
FAX: 800-822-2496
Languages Spoken:

English, Spanish

Program Website

 

Patient Assistance Applications

Celgene Patient Assistance Application

Celgene Patient Assistance Application (Spanish)

 

Medications

  • Revlimid Capsule 5mg, 10mg, 15mg, 20mg, 25mg (lenalidomide)
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Yes
Income Not disclosed
Diagnosis/Medical Criteria Not required
US Residency Required? Yes, with prescription from US doctor
   

Application

Obtaining Call, download or apply online
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Patient and Doctor notified of acceptance
Decision Timeframe Within 24-48 hours
   

Medication

Amount/Supply Up to 1 month supply
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient or Doctor must contact company
Limit None
Re-application Company contacts patient about reapplying
   

Additional Information




Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 4.
Scroll down to see them all.
Updated August 01, 2014
 

Revlimid

Celgene Co-pay Assistance Program

This is a copay assistance program.

Provided by: Celgene Corporation

Celgene Patient Support
110 Allan Road
Basking Ridge, NJ 07920

TEL: 800-931-8691


ALT PHONE:
FAX: 800-822-2496
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

 Celgene Co-pay Assistance Program: Contact program

 

Medications

  • Revlimid Capsule 5mg, 10mg, 15mg, 20mg, 25mg (lenalidomide)
 

Eligibility Requirements   

Insurance Status Must not have public insurance, may have private insurance
Those with Part D Eligible? No
Income Gross annual household income at or below $100,000
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Applicant must call for prescreening
Receiving Patient is contacted if eligible after phone screening
Returning Not specified
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Program will contact patient for information
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 24-48 hours
   

Medication

Amount/Supply Not applicable
Sent To Not applicable
Delivery Time Not applicable
Refill Process Not applicable
Limit Not specified
Re-application Not specified
   

Additional Information



Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 4.
Scroll down to see them all.
Updated October 23, 2014
 

Revlimid

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


ALT PHONE:
FAX: 810-282-0176
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Diplomat Request of Financial Assistance Form

 

Medications

  • Revlimid Capsule 5mg, 10mg, 15mg, 20mg, 25mg (lenalidomide)
 

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



Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 4 of 4. Updated October 17, 2014
 

Revlimid

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


ALT PHONE:
FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • Revlimid Capsule 5mg, 10mg, 15mg, 20mg, 25mg (lenalidomide)
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Determined case by case
Income At or below 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 Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section and sign
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

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.