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

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Daraprim Direct Program

This program provides brand name medications at no or low cost

Provided by: Vyera Pharmaceuticals, LLC

TEL: 844-267-3323

ALT PHONE: 877-258-2033
FAX: 877-241-1365
Languages Spoken:

English, Others By Translation Service

Program Website


Program Applications and Forms

Daraprim Direct Enrollment Form



  • Daraprim tablet (pyrimethamine)

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? Contact program for details.
Income At or below 500% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or US territory


Obtaining Call, download or apply online
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 and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 1-2 business days


Amount/Supply Not specified
Sent To Doctor's office or patient's home
Delivery Time 1-2 business days
Refill Process Company contacts patient to arrange
Limit Not specified
Re-application Not specified

Additional Information

Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.

Updated August 24, 2023