| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 4. Scroll down to see them all. |
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Afinitor |
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Novartis Patient Assistance Foundation, Inc. (NPAF)This program provides medication at no cost. |
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Provided by: Novartis Pharmaceuticals Corporation |
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PO Box 52029 TEL: 800-277-2254FAX: 855-817-2711 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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Novartis Patient Assistance Foundation, Inc. Enrollment Application: Contact program |
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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 | Based on FPL | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Must be residing in the US or US territory | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed | ||
| Returning | Fax or mail | ||
| Doctor's Action | Complete section, sign, attach required documents | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | Varies | ||
| Sent To | Patient's home, unless otherwise noted | ||
| Delivery Time | Not specified | ||
| Refill Process | Contact program for details. | ||
| Limit | Not specified | ||
| Re-application | New application, new documentation yearly | ||
Additional Information |
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| Novartis Oncology Products: To start the application process apply to PANO (Patient Assistance Now Oncology) at www.patient.novartisoncology.com or (800) 282-7630. Kesimpta: To start the application process apply to Alongside™ Kesimpta at www.Kesimpta.com or (855) 537-4678. Leqvio: To start the application process apply to Leqvio Service Center at www.Leqvio.com or (833) 537-8462. Mayzent: To start the application process apply to Alongside™ Mayzent at www.Mayzent.com or (877) 629-9368. All medication will be shipped directly to the patient, unless otherwise noted. Please contact the program for a complete product listing. www.pap.novartis.com |
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| Updated November 06, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 4. Scroll down to see them all. |
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Afinitor |
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PANO (Novartis Patient Assistance Now Oncology)This program provides brand name medications at no or low cost |
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Provided by: Novartis Pharmaceuticals Corporation |
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TEL: 800-282-7630 |
Languages Spoken:
English, Others By Translation Service |
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Program Applications and Forms |
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PANO (Novartis Patient Assistance Now Oncology) Patient Request Form: Contact program |
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PANO (Novartis Patient Assistance Now Oncology) HCP Request Form: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | Determined case by case | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Not applicable | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Must reside in the US, Puerto Rico or the USVI | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Faxed, mailed or complete online | ||
| Returning | Fax, mail or submit online | ||
| Doctor's Action | Enroll in the program | ||
| Applicant's Action | Call or enroll online | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | Not specified | ||
| Sent To | Doctor's office or patient's home | ||
| Delivery Time | Not specified | ||
| Refill Process | Contact program for details. | ||
| Limit | None | ||
| Re-application | New application yearly | ||
Additional Information |
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| Eligibility determined on a case-by-case basis. Co-payment assistance, and patient assistance programs are available for eligible patients. |
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| Updated November 06, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 4. Scroll down to see them all. |
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Afinitor |
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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TEL: 800-675-8416 |
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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Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | ||
| Those with Part D Eligible? | Yes, but contact program for details | ||
| 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 | Varies | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient notified | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Automatically sent out | ||
| Limit | Contact the program for details | ||
| 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 October 17, 2023 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 4 of 4. | |||
Afinitor |
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Patient Access Network Foundation (PAN)This is a copay assistance program |
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Provided by: Patient Access Network Foundation |
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TEL: 866-316-7263FAX: 866-316-7261 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Patient Access Network Foundation (PAN) Application: Contact program |
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Medications |
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Eligibility Requirements |
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| Insurance Status | *See Additional Information section below | ||
| Those with Part D Eligible? | Determined case by case | ||
| Income | Between 400-500% of FPL | ||
| Diagnosis/Medical Criteria | FDA Approved Diagnosis - See Program Website for Details | ||
| US Residency Required? | Must reside and receive treatment in US | ||
Application |
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| Obtaining | Call or complete online | ||
| Receiving | Complete online or by phone | ||
| Returning | Not applicable | ||
| Doctor's Action | Varies | ||
| Applicant's Action | Call for information or inform doctor that he/she is in need | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 48 hours | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Patient is sent savings card to be used at pharmacy | ||
| Delivery Time | Once approved; shipped same day | ||
| Refill Process | Patient presents voucher/card to pharmacy for each refill | ||
| Limit | None | ||
| Re-application | New application every 12 months | ||
Additional Information |
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| *Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details. |
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| Updated December 04, 2023 | |||
