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This program provides brand name medications at no or low cost.
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| Pharmaceutical Company |
InterMune Pharmaceuticals |
| Program Name |
Actimune Patient Assistance Program |
| Program Address |
PO Box 4280
Gaithersburg, MD 20885 |
| Phone Number |
800-577-9112, ext 1
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| Fax Number |
240-632-3873 |
| Medications on Program |
Actimmune Injection 100mcg/ 0.5ml (interferon gamma 1b)
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| Application Forms |
Not Applicable |
On-line Application
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| Web Site |
Click to go to program's web site |
| Eligibility Guidelines and Notes |
This program is based on guidelines that are not disclosed. meet income guidelines that are not disclosed. The medication must be used for a FDA-approved diagnosis. US residency requirements are
not specified. Each applicant is handled on a case by case basis.
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| Application Process |
The doctor, patient, social worker or patient advocate must call for a prescreening. The application is sent to the doctor's office. The completed application must be mailed back.
Both the patient and doctor are notified of acceptance into the program. The decision is made during the phone screening, then application is sent. The medication is shipped out within 5-7 business days.
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| Application Requirements |
The doctor must fill out a section, sign the application and attach a copy of the DEA or State License number. The patient must fill out a section, sign the application and attach proof of income.
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| Program Details |
A 90-day supply is sent to the doctor's office, hospital or pharmacy. The doctor/doctor's office must contact the company to arrange refills. Once a year a new application with financial documentation is needed.
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| Last Updated |
November 09, 2009 |
