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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Arikares Support Program

This program provides patient support assistance

Provided by: Insmed Incorporated

Attn: Arikares
700 US Highway 202/206
Bridgewater, NJ 08807

TEL: 833-274-5273


ALT PHONE: 973-437-2376
FAX: 800-604-6027
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Arikares Support Program Enrollment Form and Prescription

 

Medications

  • amikacin liposome (Arikayce Kit) 
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Yes
Income Varies
Diagnosis/Medical Criteria Must be 18 yr old or older
US Residency Required? Must live in one of the 50 states, the District of Columbia, or Puerto Rico* and utilize the US healthcare system
   

Application

Obtaining Call or download
Receiving Downloaded from website
Returning Email or fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section and sign
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication

Amount/Supply 28 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Pharmacy contacts patient
Limit Varies
Re-application Varies
   

Additional Information

This program provides copay assistance.
Education and support services are available; Contact program for details.

Updated September 15, 2020


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

HealthWell Foundation Copay Program

This is a copay assistance program

Provided by: HealthWell Foundation

PO Box 489
Buckeystown, MD 21717

TEL: 800-675-8416


FAX: 800-282-7692
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

HealthWell Foundation Copay Program Enrollment: Contact program

HealthWell Foundation COVID-19 Ancillary Costs: Contact program

 

Medications

  • amikacin () 
 

Eligibility Requirements   

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

Obtaining Call or complete online
Receiving Sent out or may be completed online
Returning Mail
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

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

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.
Updated July 20, 2020