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

This program provides brand name medications at no or low cost

Provided by: Genzyme Corporation

One to One Support Services
PO Box 220790
Charlotte, NC 28222-0790

TEL: 855-676-6326


FAX: 855-557-2478
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

MS One to One Start Form (Aubagio)

MS One to One Start Form (Lemtrada): Contact program

 

Brand Name Medications Covered

 
  • Aubagio tablet
  • Lemtrada
 

Generic Name

 
  • alemtuzumab
  • teriflunomide tablet
 

Eligibility Requirements   

Insurance Status Must be uninsured or rendered uninsured
Those with Part D Eligible? No
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be US citizen or legal entrant
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign application and consent
Decision Communicated Patient notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Patient's home
Delivery Time Not specified
Refill Process Automatically sent out
Limit One year
Re-application Company contacts patient about reapplying
   

Additional Information

Patient must have a US prescriber.


Updated November 14, 2017