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

Daiichi Sankyo Open Care Program

This program provides brand name medications at no or low cost

Provided by: Daiichi Sankyo, Inc.

PO Box 8409
Somerville, NJ 08876

TEL: 866-268-7327


FAX: 866-217-7171
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Daiichi Sankyo Open Care Program Enrollment Form

 

Brand Name Medications Covered

 
  • Azor
  • Savaysa
  • Benicar
  • Tribenzor
  • Benicar HCT
  • Welchol
 

Generic Name

 
  • amlodipine besylate/olmesartan medoxomil
  • hydrochlorothiazide/olmesartan medoxomil
  • colesevelam
  • olmesartan medoxomil
  • edoxaban
  • olmesartan medoxomil/amlodipine/ hydrochlorothiazide
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage
Those with Part D Eligible? No
Income At or below 200% of FPL
Diagnosis/Medical Criteria Not specified
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call
Receiving Faxed
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified of denial in writing
Decision Timeframe Not specified
   

Medication

Amount/Supply Up to 90 day supply
Sent To Doctor's office
Delivery Time Within 2 weeks
Refill Process *See Additional Information section below
Limit Not specified
Re-application *See Additional Information section below
   

Additional Information

*Please refer to the Refill/Reorder Instructions on the application for details.


Updated August 22, 2017