| Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis. | |||
Arikares Support ProgramThis program provides brand name medications at no or low cost |
|||
Provided by: Insmed Incorporated |
|||
TEL: 833-274-5273ALT PHONE: 973-437-2376 FAX: 800-604-6027 |
Languages Spoken:
English, Spanish, Others By Translation Service |
||
Program Applications and Forms |
|||
Arikares Support Program Enrollment Form and Prescription (pages 1-4) |
|||
Arikares Support Understanding the Arikares Support Program (pages 5-8) |
|||
Medications |
|||
|
|||
Eligibility Requirements |
|||
| 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 |
|||
| 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 | Contact program for details. | ||
| Limit | Varies | ||
| Re-application | Varies | ||
Additional Information |
|||
| Co-payment assistance, patient support, and patient assistance programs are available for eligible patients. |
|||
| Updated May 04, 2023 | |||
