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

Patient Access Program (Katerzia)

This program provides brand name medications at no or low cost

Provided by: Azurity Pharmaceuticals, Inc.

1710 N Shelby Oaks Dr. #1
Memphis, TN 38134

TEL: 844-472-2032


FAX: 866-927-2052
Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

Katerzia Patient Assistance Program Form

Katerzia Patient Enrollment and Prescription Form

 

Medications

  • amlodipine benzoate oral suspension (Katerzia) Oral Suspension
 

Eligibility Requirements   

Insurance Status Uninsured or Underinsured with no prescription coverage for needed medication
Those with Part D Eligible? Yes, if product is not covered
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be treated by US licensed healthcare provider
   

Application

Obtaining Download from website
Receiving Downloaded from website
Returning Fax or mail from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified by phone
Decision Timeframe Not specified
   

Medication

Amount/Supply 30 day supply
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Yearly a new application with new documentation
Limit Varies
Re-application Once a year new application required. Financial documentation may be requested any time
   

Additional Information

Patient must sign the enrollment form to give the program permission to access their financial information in order to determine eligibility.

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

Updated September 11, 2020