Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 3.
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Viatris Patient Assistance Program (Group One Medicines)

This program provides brand name medications at no or low cost

Provided by: Viatris Inc.


TEL: 888-417-5780


FAX: 877-427-7290
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Viatris Patient Assistance Program (Group One Medicines) Application

Viatris Patient Assistance Program (Group One Medicines) Application (Clozapine)

 

Medications

  • Alprostadil suppository; urethral (Muse) Suppository; Urethral
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? Not specified
Income Determined case by case
Diagnosis/Medical Criteria FDA-approved 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 or downloaded from website
Returning Email or fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Varies
Delivery Time Varies
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Eligibility determined on a case-by-case basis.
Contact program for details.

Updated July 18, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 3.
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Pfizer RxPathways

This program provides patient support assistance

Provided by: Pfizer, Inc.


TEL: 844-989-7284


Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Pfizers RxPathways: Contact program

 

Medications

  • alprostadil injection (Caverject Impulse) Injection
 

Eligibility Requirements   

Insurance Status Contact program for details.
Those with Part D Eligible? Contact program for details.
Income Varies
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or US territory
   

Application

Obtaining Call for prescreening or apply online
Receiving Varies
Returning Varies
Doctor's Action Varies
Applicant's Action Call or enroll online
Decision Communicated Not specified
Decision Timeframe Varies
   

Medication

Amount/Supply Contact the program for more details.
Sent To Varies
Delivery Time Varies
Refill Process Varies per medication
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Co-payment assistance, and patient assistance programs are available for eligible patients.

Call for most recent medications as the list is subject to change.

Updated July 06, 2022


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 3 of 3.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • alprostadil injection (Prostin VR Pediatric) Injection
  • Alprostadil suppository; urethral (Muse) Suppository; Urethral
 

Eligibility Requirements   

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

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

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

*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.

Updated August 05, 2022