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

Lantus SoloSTAR Pen

 View Coupon View Coupon

Sanofi Patient Connection

This program provides brand name medications at no or low cost

Provided by: Sanofi-Aventis U.S. LLC

PO Box 222138
Charlotte, NC 28222-2138

TEL: 888-847-4877


FAX: 888-847-1797 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Sanofi Patient Connection Program Application

Sanofi Patient Connection Program Application (Spanish)
 

Medications
  • Lantus SoloSTAR Pen injection (insulin glargine)
 

Eligibility Requirements   
Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Contact program for details.
Income At or below 400% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
   

Application
Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach a copy of proof of income
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-4 business days
   

Medication
Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 2-4 business days
Refill Process Reorder form needs to be submitted
Limit None
Re-application New application, new documentation yearly
   

Additional Information
Negative decision may be appealed. Insurance benefits, claims assistance and/or other reimbursement help is offered. Exceptions to guidelines considered.

Patients who do not file taxes must either request a 4506-T form from the IRS, submit proof of benefits received (such as Social Security) Earning Statement, or submit W2's of the person who is supporting them financially.

Healthcare provider must contact the Program for REORDER FORMS.
Updated January 21, 2021