| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | ||||||
Diplomat's Co-Pay Assistance Navigator ProgramThis is a copay assistance program |
||||||
Provided by: Diplomat Specialty Pharmacy |
||||||
TEL: Closed Program |
Languages Spoken:
English
|
|||||
Patient Assistance Applications |
||||||
Generic Name Medications |
||||||
|
| ||||||
Eligibility Requirements |
||||||
| Insurance Status | Determined case by case | |||||
| Those with Part D Eligible? | Yes | |||||
| Income | Determined case by case | |||||
| Diagnosis/Medical Criteria | Medically appropriate condition/diagnosis | |||||
| US Residency Required? | Yes | |||||
Application |
||||||
| Obtaining | Call or complete online | |||||
| Receiving | Faxed, mailed or complete online | |||||
| Returning | Fax or mail | |||||
| Doctor's Action | Will be discussed with patient and Doctor after request is received | |||||
| Applicant's Action | Complete section, sign and provide annual income information. Proof of income may be request by program at any time | |||||
| Decision Communicated | ||||||
| Decision Timeframe | ||||||
Medication |
||||||
| Amount/Supply | ||||||
| Sent To | ||||||
| Delivery Time | ||||||
| Refill Process | ||||||
| Limit | ||||||
| Re-application | Determined case by case | |||||
Additional Information |
||||||
| Closed Program Diplomat Specialty Pharmacy is a full service pharmacy that can help patients seek funding assistance for the copay portion of their required medications. Applications can be completed online or Prescription, Demographics and Proof of Income may be faxed to 810-282-0176 Attn: Dorrie |
||||||
| Updated February 02, 2017 | ||||||
