| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
View Coupon |
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Daraprim Direct ProgramThis program provides brand name medications at no or low cost |
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Provided by: Vyera Pharmaceuticals, LLC |
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TEL: 844-267-3323ALT PHONE: 877-258-2033 FAX: 877-241-1365 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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Daraprim Direct Enrollment Form |
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Medications |
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Eligibility Requirements |
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| 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 | ||
Application |
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| 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 | ||
Medication |
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| 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 |
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| Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients. |
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| Updated December 08, 2022 | |||
