Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Amgen Safety Net Foundation (ASNF)

This program provides medication at no cost.

Provided by: Amgen, Inc.


TEL: 888-762-6436


Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

Amgen Safety Net Foundation: Contact program
 

Medications
  • adalimumab-atto injection; subcutaneous (Amjevita) Injection; Subcutaneous
 

Eligibility Requirements   
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Yes, but contact program for details
Income At or below 500% of FPL
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Yes, must have lived in the US or its territories for 6 months or longer.
   

Application
Obtaining Call or download from Programs website
Receiving Mailed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section and sign
Decision Communicated Patient and Doctor are notified
Decision Timeframe Varies
   

Medication
Amount/Supply Contact the program for more details.
Sent To Varies
Delivery Time Contact Program for Details
Refill Process Determined on a case by case basis
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information
Please visit (www.SafetyNetFoundation.com) (www.AmgenAssist360.com) for more information.
Updated May 22, 2023


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

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
  • adalimumab-atto autoinjector; pre-filled (Amjevita SureClick) AutoInjector; Pre-filled
  • adalimumab-atto injection; subcutaneous (Amjevita) Injection; Subcutaneous
 

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 May 01, 2023