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

Cayston Patient Assistance Program

This program provides brand name medications at no or low cost

Provided by: Gilead Sciences, Inc.

PO Box 13185
La Jolla, CA 92039-3185

TEL: 877-722-9786


ALT PHONE: 877-290-6014
FAX: 877-550-1705
Languages Spoken:

English, Others By Translation Service

Program Website

 

Patient Assistance Applications

Cayston Patient Assistance Program Patient Enrollment Form

 

Brand Name Medications Covered

 
  • Altera Nebulizer for Cayston nebulizer system
  • Cayston
 

Generic Name

 
  • altera nebulizer for cayston nebulizer system
  • aztreonam
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Based on FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be a US resident
   

Application

Obtaining Call
Receiving Faxed or mailed
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach proof of income
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe 3-5 business days
   

Medication

Amount/Supply Up to 1 month supply
Sent To Patient's home, unless otherwise noted
Delivery Time Within 2 business days
Refill Process Patient contacts pharmacy
Limit Not specified
Re-application Not specified
   

Additional Information


Updated October 19, 2017