| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
| Program 1 of 2. Scroll down to see them all. |
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Arikares Support ProgramThis program provides brand name medications at no or low cost |
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Provided by: Insmed Incorporated |
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TEL: 833-274-5273ALT PHONE: 973-437-2376 FAX: 800-604-6027 |
Languages Spoken:
English, Spanish, Others By Translation Service |
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Program Applications and Forms |
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Arikares Support Program Enrollment Form and Prescription (pages 1-4) |
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Arikares Support Understanding the Arikares Support Program (pages 5-8) |
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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? | Yes, but contact program for details | ||
| 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 |
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| 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 |
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| Amount/Supply | 28 day supply | ||
| Sent To | Patient's home, unless otherwise noted | ||
| Delivery Time | Varies | ||
| Refill Process | Contact program for details. | ||
| Limit | Varies | ||
| Re-application | Varies | ||
Additional Information |
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| Co-payment assistance, patient support, and patient assistance programs are available for eligible patients. |
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| Updated May 04, 2023 | |||
| 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 ProgramThis is a copay assistance program |
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Provided by: HealthWell Foundation |
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TEL: 800-675-8416 |
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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Medications |
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Eligibility Requirements |
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| Insurance Status | May have insurance | ||
| Those with Part D Eligible? | Yes, but contact program for details | ||
| 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 | Varies | ||
| Returning | |||
| Doctor's Action | Complete section and sign | ||
| Applicant's Action | Complete section, sign, attach required documents | ||
| Decision Communicated | Patient notified | ||
| Decision Timeframe | 3-5 business days | ||
Medication |
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| Amount/Supply | Not applicable | ||
| Sent To | Varies | ||
| Delivery Time | Not specified | ||
| Refill Process | Automatically sent out | ||
| Limit | Contact the program for details | ||
| 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 May 30, 2023 | |||
