Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Sandostatin LAR

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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

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • Sandostatin LAR (octreotide acetate)
 

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.

Updated July 10, 2015


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Sandostatin LAR

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Novartis Oncology Patient Assistance Program

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

Provided by: Novartis Pharmaceuticals

PO Box 52029
Phoenix, AZ 85072-2029

TEL: 866-884-5906


ALT PHONE: 800-282-7630
FAX: 888-891-4924
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Novartis Service Request Form for Patient Support

 

Medications

  • Sandostatin LAR injection (octreotide acetate)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? Considered on exception basis
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Doctor must ask for service request
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section, sign, attach prescription
Applicant's Action Complete section, sign, attach proof of income and any insurance information
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time Not specified
Refill Process Patient must contact company
Limit None
Re-application New application yearly
   

Additional Information

Eligibility determined on a case-by-case basis.

Uninsured patients, call 1-866-884-5906
Patients with insurance, call 1-800-282-7630

This program also provides copay assistance up to $36,000 per year for Signifor and $9,600 per year for Sandostatin. Carcinoid tumor patients are now eligible.
Updated August 20, 2015