| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 3. Scroll down to see them all. |
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Catalyst PathwaysThis program provides brand name medications at no or low cost |
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Provided by: Catalyst Pharmaceuticals, Inc. |
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c/o AnovoRx Manufacturer Services, LLC TEL: 833-422-8259FAX: 833-422-8260 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Catalyst Pathways Enrollment Form |
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Catalyst Pathways Enrollment Form Instructions |
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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 | Based on FPL | ||
| Diagnosis/Medical Criteria | Medically Necessary as determined by a Doctor | ||
| US Residency Required? | Must reside in the US | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Faxed or downloaded from website | ||
| Returning | Fax | ||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section and sign | ||
| Decision Communicated | Patient and Doctor are notified | ||
| Decision Timeframe | Within 72 hours | ||
Medication |
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| Amount/Supply | Up to 1 month supply | ||
| Sent To | Patient's home, unless otherwise noted | ||
| Delivery Time | Varies | ||
| Refill Process | Pharmacy contacts patient | ||
| Limit | Varies | ||
| Re-application | Must re-enroll at end of calendar year | ||
Additional Information |
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| This program also provides co-pay and reimbursement assistance. |
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| Updated August 20, 2020 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 2 of 3. Scroll down to see them all. |
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Ruzurgi Patient AssistanceThis program provides patient support assistance |
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Provided by: Jacobus Pharmaceutical Company, Inc. |
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Attn: PANTHERx Specialty Pharmacy TEL: 844-789-8744FAX: 877-203-8844 |
Languages Spoken:
English |
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Program Applications and Forms |
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Ruzurgi Patient Assistance Treatment Form |
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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 | Not disclosed | ||
| Diagnosis/Medical Criteria | Not specified | ||
| US Residency Required? | Not specified | ||
Application |
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| Obtaining | Call or download | ||
| Receiving | Downloaded from website | ||
| Returning | Fax from Doctor's office | ||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section and sign | ||
| Decision Communicated | Not specified | ||
| Decision Timeframe | Not specified | ||
Medication |
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| Amount/Supply | Contact the program for more details. | ||
| Sent To | Varies | ||
| Delivery Time | Contact Program for Details | ||
| Refill Process | Contact program for details. | ||
| Limit | Contact the program for details | ||
| Re-application | Contact program for details. | ||
Additional Information |
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| This program provides copay assistance. |
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| Updated September 11, 2020 | |||
| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 3 of 3. | |||
HealthWell Foundation Copay ProgramThis is a copay assistance program |
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Provided by: HealthWell Foundation |
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PO Box 489 TEL: 800-675-8416FAX: 800-282-7692 |
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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HealthWell Foundation COVID-19 Ancillary Costs: 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 | ||
| 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 | Sent out or may be completed online | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach a copy of proof of income | ||
| Decision Communicated | Patient notified in writing | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Good for one year | ||
| Limit | Not specified | ||
| 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 July 20, 2020 | |||
