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

OneSource Treatment Support (Soliris)

This program provides brand name medications at no or low cost

Provided by: Alexion Pharmaceuticals, Inc.

100 College St
New Haven, CT 06510

TEL: 888-765-4747

FAX: 800-420-5150
Languages Spoken:

English, Spanish

Program Website


Patient Assistance Applications

OneSource Enrollment and Authorization Form (Soliris)

OneSource Enrollment and Authorization Form (Soliris) (Spanish)


Brand Name Medications Covered

  • Soliris injectable; iv

Generic Name

  • eculizumab injectable; iv

Eligibility Requirements   

Insurance Status Determined case by case
Those with Part D Eligible? No
Income Determined case by case
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Not specified


Obtaining Call or download
Receiving Downloaded from website
Returning Email, fax or mail
Doctor's Action Doctor is required to submit medical information for screening
Applicant's Action Complete authorization and release forms available on website
Decision Communicated Not specified
Decision Timeframe Not specified


Amount/Supply Not specified
Sent To Not specified
Delivery Time Not specified
Refill Process Determined on a case by case basis
Limit Not specified
Re-application Not specified

Additional Information

Insurance benefits, claims assistance, or other reimbursement help is offered.

This program also provides copay assistance.

Updated September 27, 2018