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

Circle of Care Patient Assistance Program

For Healthcare Professionals Only

Provided by: Organogenesis Inc.


TEL:


FAX: 866-212-2888
Languages Spoken:

English

Program Website

 

Program Applications and Forms

Circle of Care Patient Assistance Program Application

 

Medications

  • antimicrobial matrix-wound wound dressing; antimicrobial (PuraPly AM) Wound Dressing; Antimicrobial
 

Eligibility Requirements   

Insurance Status Must be uninsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must reside in the US
   

Application

Obtaining Doctor/Doctor's office must call
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Doctor notified
Decision Timeframe Not specified
   

Medication

Amount/Supply Not specified
Sent To Doctor's office
Delivery Time Varies
Refill Process Contact program for details.
Limit Contact the program for details
Re-application Contact program for details.
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.


Updated November 03, 2022