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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
Allos Therapeutics |
| Program Name |
Allos Support for Assisting Patients (ASAP) |
| Program Address |
Allos Support for Assisting Patients
c/o AccessMED, Inc
6900 College Blvd Ste 1000
Overland Park, KS 66211 |
| Phone Number |
877-272-7102
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| Fax Number |
877-801-0777 |
| Medications on Program |
Folotyn Vial 20mg, 40mg (pralatrexate)
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| Application Forms |
ASAP Enrollment Form
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On-line Application
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| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
The patient can have no public or private prescription insurance and meet income guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis. US residency requirements are
not specified. This program will assist in appeals for those with insurance.
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| Application Process |
Anyone requesting assistance can call to get an enrollment form sent out, or download it from the website. The application can be faxed, mailed out or downloaded from website. The completed application can be faxed or mailed back.
Both the doctor and patient are notified or acceptance or denial. The medication is shipped the next business day.
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| Application Requirements |
The doctor must fill out a section and sign the application. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
The medication is sent to the doctor's office, hospital or pharmacy.
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| Last Updated |
October 02, 2009 |
