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

Novartis Patient Assistance Foundation, Inc.

This program provides brand name medications at no or low cost

Provided by: Novartis Pharmaceuticals

PO Box 52029
Phoenix, AZ 85072-2029

TEL: 800-277-2254


FAX: 855-817-2711
Languages Spoken:

English, Others By Translation Service

Program Website

 

Patient Assistance Applications

Novartis Patient Assistance Foundation, Inc. Enrollment Application

Novartis Patient Assistance Foundation, Inc. Enrollment Application (Spanish)

 

Brand Name Medications Covered

 
  • Afinitor
  • Pataday ophthalmic solution/drops
  • Afinitor Disperz
  • Pazeo ophthalmic solution
  • Arranon injection
  • Promacta
  • Arzerra injection
  • Reclast injectable; iv (infusion)
  • Azopt ophthalmic suspension/drops
  • Sandimmune
  • Ciprodex solution/drops; otic
  • Sandostatin LAR injection
  • Coartem tablet
  • Signifor
  • Durezol ophthalmic emulsion
  • Signifor LAR
  • Entresto tablet
  • Simbrinza ophthalmic suspension/drops
  • Exjade
  • Tafinlar capsule
  • Farydak capsule
  • Tasigna capsule
  • Focalin XR capsule; extended release
  • Tegretol
  • Glatopa injection
  • Tegretol XR tablet; extended release
  • Hycamtin
  • Tobi Podhaler powder; inhalation
  • Ilevro ophthalmic suspension/drops
  • Tobi solution; inhalation
  • Jadenu
  • Travatan Z ophthalmic solution/drops
  • Jadenu Sprinkle granule
  • Trileptal tablet
  • Kisqali
  • Tykerb tablet
  • Kisqali Femara tablet; co-pack
  • Vigamox ophthalmic solution/drops
  • Mekinist tablet
  • Votrient tablet
  • Myfortic tablet; delayed release
  • Zometa
  • Neoral
  • Zortress tablet
  • Omnitrope
  • Zykadia capsule
 

Generic Name

 
  • artmether/lumefantrine tablet
  • nepafenac ophthalmic suspension/drops
  • brimonidine tartrate/brinzolamide ophthalmic suspension/drops
  • nilotinib monohydrate capsule
  • brinzolamide ophthalmic suspension/drops
  • octreotide acetate injection
  • carbamazepine
  • ofatumumab injection
  • carbamazepine tablet; extended release
  • olopatadine ophthalmic solution
  • ceritinib capsule
  • olopatadine ophthalmic solution/drops
  • ciprofloxacin/dexamethasone sterile otic suspension solution/drops; otic
  • oxcarbazepine tablet
  • cyclosporine
  • panobinostat lactate capsule
  • dabrafenib capsule
  • pasireotide
  • deferasirox
  • pasireotide diaspartate
  • deferasirox granule
  • pazopanib tablet
  • dexmethylphenidate capsule; extended release
  • ribociclib
  • difluprednate ophthalmic emulsion
  • ribociclib-letrozole tablet; co-pack
  • eltrombopag
  • sacubitril/valsartan tablet
  • everolimus
  • somatropin (rDNA origin)
  • everolimus tablet
  • tobramycin powder; inhalation
  • glatiramer acetate injection
  • tobramycin solution; inhalation
  • lapatinib ditosylate tablet
  • topotecan
  • levoleucovorin calcium injection
  • trametinib dimethyl sulfoxide tablet
  • moxifloxacin ophthalmic solution/drops
  • travoprost ophthalmic solution/drops
  • mycophenolic acid tablet; delayed release
  • zoledronic acid
  • nelarabine injection
  • zoledronic acid injectable; iv (infusion)
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria Not specified
US Residency Required? Yes
   

Application

Obtaining Call or download
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section, sign, attach prescription for 90 days
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Doctor notified via mailed letter
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Doctor's office or patient is sent card to be used at pharmacy
Delivery Time Not specified
Refill Process Refill/reorder form included with shipment
Limit Not specified
Re-application New application, new documentation yearly
   

Additional Information

For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the physician.

*Additional products may be available. Please contact the program for a complete product listing. www.pap.novartis.com
Updated December 06, 2017