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

MyPraluent Patient Assistance Program (PAP)

This program provides brand name medications at no or low cost

Provided by: Regeneron Pharmaceuticals, Inc.

PO Box 592188
Orlando, FL 32859-2188

TEL: 844-772-5836


FAX: 844-855-7278
Languages Spoken:

English, Spanish

Program Website

 

Program Applications and Forms

MyPraluent Patient Assistance Program (PAP) Enrollment Form

 

Medications

  • alirocumab injection; prefilled pen (Praluent) Injection; Prefilled Pen
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Determined case by case
Income At or below 300% of FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must live in US, DC or Puerto Rico
   

Application

Obtaining Call, download or apply online
Receiving Complete online, download from website or faxed.
Returning Fax or mail (Note: faxed prescriptions are only valid if faxed directly from a prescriber's office)
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 Varies
   

Medication

Amount/Supply As prescribed by Doctor
Sent To Patient's home
Delivery Time Varies
Refill Process Patient requests refills via a toll-free number
Limit Varies
Re-application New application yearly
   

Additional Information

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

Updated August 17, 2021