| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 2. Scroll down to see them all. |
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Takeda Help at Hand Patient Assistance ProgramThis program provides brand name medications at no or low cost |
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Provided by: Takeda Pharmaceutical |
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PO Box 5727 TEL: 800-830-9159FAX: 800-497-0928 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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Takeda Patient Assistance Program Application |
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Takeda Expands Assistance During COVID-19 Crisis Information Letter |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Must have no coverage for the requested medication, be ineligible for federal or state programs | ||
| Those with Part D Eligible? | Yes | ||
| Income | At or below 500% of FPL | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Yes | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed, mailed or downloaded from website | ||
| Returning | Fax or mail from Doctor's office | ||
| Doctor's Action | Complete section, sign, attach prescription and include the DEA or state license number | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Patient and Doctor notified of acceptance | ||
| Decision Timeframe | 5-7 business days | ||
Medication |
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| Amount/Supply | Up to 90 day supply | ||
| Sent To | Doctor's office or patient's home | ||
| Delivery Time | Not specified | ||
| Refill Process | Not specified | ||
| Limit | Not specified | ||
| Re-application | New application, new documentation yearly | ||
Additional Information |
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| Applicants not approved for enrollment in the program may have the opportunity to seek an exception to the program criteria. |
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| Updated December 14, 2020 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 2. | |||
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View Coupon |
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HealthWell Foundation Copay ProgramThis is a copay assistance program |
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Provided by: HealthWell Foundation |
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PO Box 489 TEL: 800-675-8416FAX: 800-282-7692 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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HealthWell Foundation Copay Program Enrollment: Contact program |
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HealthWell Foundation COVID-19 Ancillary Costs: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | ||
| Those with Part D Eligible? | Yes | ||
| Income | Varies | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Sent out or may be completed online | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Patient notified in writing | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Good for one year | ||
| Limit | Not specified | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| This program provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. Also, for those who are eligible for health insurance, but cannot afford the insurance premium, the foundation may be able to help by paying some or all of the medical portion of insurance premiums. The patient is being treated for a specific disease for which funding is available and has insurance that covers the treatment for this disease. Call for most recent medications as the list is subject to change. |
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| Updated January 25, 2021 | |||
