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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Otezla SupportPlus Program

This program provides brand name medications at no or low cost

Provided by: Celgene Corporation


TEL: 844-468-3952


FAX: 844-269-3053
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Otezla SupportPlus Patient Assistance Application

 

Medications

  • apremilast tablet (Otezla) Tablet
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? Determined case by case
Income At or below 400% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must reside permanently in the US or US territories
   

Application

Obtaining Call
Receiving Not applicable
Returning Not applicable
Doctor's Action Fax in prescription
Applicant's Action The patient responds to questions over the phone to verify eligibility
Decision Communicated Decision made during phone screening
Decision Timeframe Decision made during phone screening
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Within 1 week of receiving perscription
Refill Process Company contacts patient to arrange
Limit One calendar year
Re-application Must re-enroll at end of calendar year
   

Additional Information

*Patients are subject to audit and must provide financial documentation

This program also provides co-pay, reimbursement assistance and adherence support.


Updated August 07, 2017


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

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

 

Medications

  • apremilast (Otezla) 
 

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 June 29, 2017