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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Azurity Solutions: 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, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Azurity Solutions: Katerzia Patient Enrollment Form and Prescription

Azurity Solutions: Katerzia Patient Assistance Program Form
 

Medications
  • amlodipine benzoate oral suspension (Katerzia) Oral Suspension
 

Eligibility Requirements   
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 be treated by US licensed healthcare provider
   

Application
Obtaining Download from website
Receiving Downloaded from website
Returning Fax or mail
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient notified
Decision Timeframe Varies
   

Medication
Amount/Supply Varies
Sent To Patient's home, unless otherwise noted
Delivery Time Varies
Refill Process Contact program for details.
Limit Varies
Re-application Contact program for details.
   

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.

This program may provide a Bridge Program for eligible patients who experience a delay, temporary loss, or change in coverage. Contact program for details.
Updated September 13, 2023


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

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program
 

Medications
  • amlodipine benzoate oral suspension (Katerzia) Oral Suspension
 

Eligibility Requirements   
Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application
Obtaining Call or complete online
Receiving Complete online or by phone
Returning Not applicable
Doctor's Action Varies
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 48 hours
   

Medication
Amount/Supply Not applicable
Sent To Patient is sent savings card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated September 25, 2023