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

View Coupon View Coupon

Kaleo Cares Patient Assistance Program (Auvi-Q)

This program provides brand name medications at no or low cost

Provided by: Kaleo, Inc.


TEL: 502-213-7601


FAX: 800-943-1730
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Kaleo Cares Patient Assistance Program Enrollment Form (Auvi-Q)

 

Medications

  • Auvi-Q injection (epinephrine)
 

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Gross annual household income at or below $100,000
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be citizen or legal resident
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified by phone
Decision Timeframe Not specified
   

Medication

Amount/Supply Varies
Sent To Patient's home
Delivery Time Within 48 hours
Refill Process Contact program for details.
Limit Contact the program for details
Re-application New application every 12 months
   

Additional Information


Updated June 10, 2021